RESUMEN
The fungus Cryptococcus neoformans can cause common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients. But other conditions can be associated with sarcoidosis. Meningoencephalitis is the most common manifestation of this disease. One of the most important neurological complications is the development of intracranial hypertension (ICH), which may result in high morbidity and mortality. We report the case of a patient harboring a ventriculoperitoneal shunt, and having contracted a cryptococcal meningitis as a risk factor for pulmonary sarcoidosis. Brain MRI showed arachnoiditis, with a mass in contact with the right frontal horn. Indian ink staining of the cerebrospinal fluid (CSF) showed positivity that was confirmed by the identification of Cryptococcus neoformans after culture. The evolution was favorable under medical treatment with removal of material. The relationship between sarcoidosis and cryptococcosis, described in the literature is not coincidental but is a rare complication of sarcoidosis of potential severity (40% of mortality). Sarcoidosis is a common systemic disease that may increase host susceptibility to CNS cryptococcal infection without any other signs or symptoms of host immunosuppression. The diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.
Asunto(s)
Aracnoiditis/etiología , Meningitis Criptocócica/etiología , Infecciones Relacionadas con Prótesis/etiología , Sarcoidosis Pulmonar/complicaciones , Derivación Ventriculoperitoneal/efectos adversos , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Aracnoiditis/líquido cefalorraquídeo , Aracnoiditis/diagnóstico , Aracnoiditis/tratamiento farmacológico , Aracnoiditis/microbiología , Carbono , Líquido Cefalorraquídeo/microbiología , Colorantes , Confusión/etiología , Cryptococcus neoformans/aislamiento & purificación , Susceptibilidad a Enfermedades , Quimioterapia Combinada , Flucitosina/administración & dosificación , Flucitosina/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis Criptocócica/líquido cefalorraquídeo , Meningitis Criptocócica/diagnóstico , Meningitis Criptocócica/tratamiento farmacológico , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/líquido cefalorraquídeo , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Agitación Psicomotora/etiología , Coloración y EtiquetadoRESUMEN
Tuberous sclerosis is a phacomatosis resulting from an autosomal dominant inheritance. It is characterized by the presence of multiple hamartomas in various organs, especially the brain, the skin, the kidneys and the heart. The diagnosis of tuberous sclerosis is based on imaging and clinical examination, where magnetic resonance imaging constitutes the key investigation showing characteristic brain lesions. Neuro-encephalic manifestations may be particularly severe, and may even be life threatening. The authors report personal cases series and review the literature highlighting epidemiology, clinical features and imaging of neuro-encephalic tuberous sclerosis.
Asunto(s)
Encéfalo/patología , Neuronas/patología , Esclerosis Tuberosa/patología , Esclerosis Tuberosa/fisiopatología , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Diagnóstico Diferencial , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/etiología , Trastornos Mentales/patología , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/patología , Neuroimagen/métodos , Neuronas/diagnóstico por imagen , Neuronas/fisiología , Radiografía , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/diagnósticoRESUMEN
Thalamo-mesencephalic neuroepithelial cysts are rare lesions of the central nervous system. They are thought to arise from neuroectoderm and are also referred to as ependymal cysts due to their origin. It can remain asymptomatic throughout life or rarely can cause symptoms. We describe a 42-year-old woman who presented with thalamic syndrome due to a neuroepithelial cyst of the thalamo-midbrain. Differential diagnosis is made with other cystic lesions in the brain. However a good analysis of imaging feature led to diagnosis. When the lesion is symptomatic, mini-invasive procedure is indicated.
Asunto(s)
Quistes del Sistema Nervioso Central/diagnóstico , Quistes del Sistema Nervioso Central/patología , Neoplasias Neuroepiteliales/diagnóstico , Neoplasias Neuroepiteliales/patología , Enfermedades Talámicas/diagnóstico , Adulto , Quistes del Sistema Nervioso Central/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Mesencéfalo/patología , Neoplasias Neuroepiteliales/cirugía , Procedimientos NeuroquirúrgicosAsunto(s)
Equinococosis Hepática/complicaciones , Equinococosis Pulmonar/complicaciones , Equinococosis , Enfermedades de la Médula Espinal/parasitología , Adulto , Albendazol/administración & dosificación , Albendazol/uso terapéutico , Anticestodos/administración & dosificación , Anticestodos/uso terapéutico , Equinococosis/tratamiento farmacológico , Equinococosis/cirugía , Equinococosis Hepática/tratamiento farmacológico , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/tratamiento farmacológico , Estudios de Seguimiento , Humanos , Laminectomía , Masculino , Radiografía Torácica , Recurrencia , Enfermedades de la Médula Espinal/tratamiento farmacológico , Enfermedades de la Médula Espinal/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The authors report the case of a 35-years-women with a thoracic disc herniation, who presented with seven years history of episodic acute ureteric colic. An early diagnosis of a spinal disc herniation was made difficult by the absence of neurological findings. Imaging studies showed no lesion in the genito-urinary tract. Magnetic resonance imaging demonstrated a postero-lateral disc herniation at T10-T11 level. The pain disappeared immediately after surgery decompression. A literature search showed that acute ureteric colic associated with a lower thoracic disc herniation has not been previously reported.
Asunto(s)
Dolor de Espalda/etiología , Cólico/diagnóstico , Errores Diagnósticos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Enfermedades Renales/diagnóstico , Vértebras Torácicas/patología , Adulto , Descompresión Quirúrgica , Diagnóstico Diferencial , Femenino , Humanos , Desplazamiento del Disco Intervertebral/patología , Región Lumbosacra , Imagen por Resonancia Magnética , Factores de TiempoRESUMEN
We report the case of a 50-year-old woman presenting a primitive adenoid cystic carcinoma of the middle part of skull base diagnosed by transphenoidal biopsy. She was treated by exclusive radiation therapy with cobalt 60 1.25 MeV and the dose received was 66 Gy in 33 fractions. Our patient remains alive 50 months after the completion of treatment. Adenoid cystic carcinoma is a slow growing malignant tumor with perineural invasion which arises more frequently from salivary glands. The occurrence of primary intracranial adenoid cystic carcinoma is exceptional. The best treatment is radical surgery followed by radiotherapy. Chemotherapy is rarely used. Prognosis is worse than for salivary glands.
Asunto(s)
Carcinoma Adenoide Quístico/cirugía , Neoplasias de la Base del Cráneo/cirugía , Biopsia , Carcinoma Adenoide Quístico/patología , Carcinoma Adenoide Quístico/radioterapia , Terapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Pronóstico , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/radioterapia , Tomografía Computarizada por Rayos XRESUMEN
Intradiploic epidermoid cyst of the skull is a rare clinical entity that can exceptionally grow to a large size with intracranial extension. The authors report the case of a 38-year-old man with a giant epidermoid cyst of the parietal bone with extra and intracranial extension, presenting with focal neurological symptoms. The diagnosis was suggested at imaging (skull radiographs, CT and MRI), and confirmed at histology. Complete removal of the cyst and its capsule was performed followed by cranioplasty. Postoperatively, the patient was discharged free of symptoms. CT scan provides good evaluation of the bony lesion and may suggest intracranial extension. MRI is superior for evaluation of cerebral compression. The pathogenesis, clinical presentation, diagnostic evaluation and therapeutic management of these rare lesions are reviewed.
Asunto(s)
Enfermedades Óseas/diagnóstico , Quiste Epidérmico/diagnóstico , Cráneo , Adulto , Biopsia , Enfermedades Óseas/complicaciones , Enfermedades Óseas/epidemiología , Enfermedades Óseas/cirugía , Diagnóstico Diferencial , Quiste Epidérmico/complicaciones , Quiste Epidérmico/epidemiología , Quiste Epidérmico/cirugía , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Metilmetacrilato/uso terapéutico , Pronóstico , Tomografía Computarizada por Rayos XAsunto(s)
Absceso Encefálico/microbiología , Enfermedades Cerebelosas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Lactococcus lactis/patogenicidad , Antibacterianos , Absceso Encefálico/diagnóstico , Absceso Encefálico/cirugía , Enfermedades Cerebelosas/diagnóstico , Enfermedades Cerebelosas/cirugía , Terapia Combinada , Quimioterapia Combinada/uso terapéutico , Femenino , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Boca/microbiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/cirugía , Succión , Cirugía Bucal , Tomografía Computarizada por Rayos X , VirulenciaRESUMEN
Central nervous system metastases from prostate cancer are exceptional secondary sites, reported in less than 4% of postmortem cases. The authors describe an unusual case of cerebral metastasis from prostate cancer in a 44-year-old man that temporarily regressed during endocrine therapy.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/secundario , Antagonistas de Andrógenos/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Acetato de Ciproterona/uso terapéutico , Neoplasias de la Próstata/tratamiento farmacológico , Adulto , Resultado Fatal , Humanos , Masculino , Neoplasias de la Próstata/patología , Inducción de RemisiónRESUMEN
We report two cases of brainstem tuberculomas with favorable outcome after medical treatment alone. Tuberculomas should be suspected in all cases presenting space-occupying lesions of the brainstem.
Asunto(s)
Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , Tuberculosis del Sistema Nervioso Central/diagnóstico , Adulto , Antiinflamatorios/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Esteroides , Tomografía Computarizada por Rayos X , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológicoRESUMEN
Behçet disease is a rare condition in central Europe but more common in Morocco. A case of multiple intracranial arterial aneurysms occurring in a 44 year-old Moroccan patient with 2-years history of Behçet's disease is reported. CT-scan showed an infarction in the right middle cerebral artery territory. Panangiography showed sacciform aneurysms of the bifurcation of the right and left middle cerebral arteries. The draining veins and sinuses were normal. The two aneurysms were successfully clipped by two microsurgical frontotemporal approach in one surgical time. There have been only eight reports of intracranial arterial aneurysms associated to Behçet disease in the literature.
Asunto(s)
Síndrome de Behçet/complicaciones , Aneurisma Intracraneal/complicaciones , Adulto , Humanos , Aneurisma Intracraneal/cirugía , Masculino , MarruecosRESUMEN
A case of intradural extramedullary neurenteric cyst is reported. The embryogenesis and surgical treatment of this lesion are discussed.
Asunto(s)
Quiste Mediastínico/complicaciones , Quiste Mediastínico/diagnóstico , Paraplejía/etiología , Espina Bífida Oculta/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Quiste Mediastínico/cirugía , Persona de Mediana Edad , Mielografía , Paraplejía/diagnóstico , Paraplejía/cirugía , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/etiologíaRESUMEN
A case of intrasacral meningocele with low back pain and sciatica as the presenting manifestations in a 47-year-old male is reported. Magnetic resonance imaging established the diagnosis. Surgical treatment was successful.