RESUMEN
OBJECTIVE: Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS: Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS: We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS: Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION: This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.
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Tumor del Cuerpo Carotídeo , Ataque Isquémico Transitorio , Humanos , Persona de Mediana Edad , Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Tumor del Cuerpo Carotídeo/cirugía , Tumor del Cuerpo Carotídeo/complicaciones , Estudios Retrospectivos , Estudios Transversales , Ataque Isquémico Transitorio/complicaciones , Procedimientos Quirúrgicos Vasculares/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: The complications of coronavirus disease 2019 (COVID-19), the clinical entity caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are not limited to the respiratory system. Leukoencephalopathy with microbleeds is increasingly seen in patients with COVID-19. New information is needed to delineate better the clinical implications of this infectious disease. CASE REPORT: A 46-year-old man with confirmed SARS-CoV-2 infection was admitted to the intensive care unit (ICU) with severe COVID-19. After transfer to the general wards, the patient was noted drowsy, disorientated, with slow thinking and speech. A brain MRI showed bilateral symmetrical hyperintense lesions in the deep and subcortical whiter matter, involving the splenium of the corpus callosum, as well as multiple microhemorrhages implicating the splenium and subcortical white matter. No contrast-enhanced lesions were observed in brain CT or MRI. CSF analysis showed no abnormalities, including a negative rtRT-PCR for SARS-CoV-2. An outpatient follow-up visit showed near-complete clinical recovery and resolution of the hyperintense lesions on MRI, without microbleeds change. CONCLUSION: We present the case of a survivor of severe COVID-19 who presented diffuse posthypoxic leukoencephalopathy, and microbleeds masquerading as acute necrotizing encephalopathy. We postulate that this kind of cerebral vasogenic edema with microbleeds could be the consequence of hypoxia, inflammation, the prothrombotic state and medical interventions such as mechanical ventilation and anticoagulation.
Asunto(s)
Infarto Encefálico , COVID-19 , Leucoencefalopatías , Humanos , Masculino , Persona de Mediana Edad , Anticoagulantes , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/etiología , COVID-19/complicaciones , COVID-19/diagnóstico , Leucoencefalopatías/etiología , Leucoencefalopatías/complicaciones , SARS-CoV-2 , Infarto Encefálico/etiologíaRESUMEN
INTRODUCTION: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. OBJECTIVE: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. METHOD: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. RESULTS: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. CONCLUSIONS: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.
INTRODUCCIÓN: La enfermedad carotídea aterosclerosa (ECA) es un factor de riesgo importante para enfermedad vascular cerebral. OBJETIVO: Analizar la asociación entre factores de riesgo vascular mayores con ECA y leucopatía cerebral en pacientes sin historia de ictus isquémico. MÉTODO: Se evaluaron factores de riesgo en sujetos con exploración de carótidas mediante ultrasonografía Doppler dúplex. No se incluyeron casos con historia de infarto cerebral o ataque isquémico transitorio. Los sujetos contaron con resonancia magnética cerebral y se excluyeron aquellos con lesiones isquémicas de grandes vasos. Se construyeron modelos multivariable para la predicción de ECA, estenosis carotídea significativa, carga de ateromas y leucopatía cerebral. RESULTADOS: Se estudiaron 145 sujetos (60.7 % mujeres, edad de 73 años). Se documentó ECA en 54.5 %, estenosis carotídea ≥ 50 % en 9 %, carga de placas de ateroma > 6 en 7.6 % y leucopatía periventricular o subcortical en 28.3 % (20.6 % tenían concurrentemente ECA y leucopatía). Los factores asociados independientemente con ECA fueron edad e hipertensión; con estenosis ≥ 50 %, hipertensión; con cargas de ateromas > 6 placas, edad; con leucopatía, edad, diabetes e hipertensión. La obesidad no se asoció con las variables independientes analizadas. CONCLUSIONES: En los sujetos asintomáticos sin historia de ictus isquémico, la edad y la hipertensión fueron los factores de riesgo más importantes para enfermedad macrovascular. La diabetes mellitus se asoció con enfermedad microvascular. La obesidad por sí sola no fue un determinante mayor de ECA o leucopatía cerebral.
Asunto(s)
Enfermedades de las Arterias Carótidas/epidemiología , Estenosis Carotídea/epidemiología , Leucoencefalopatías/epidemiología , Placa Aterosclerótica/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Leucoencefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Placa Aterosclerótica/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Ultrasonografía Doppler DúplexRESUMEN
Resumen Introducción: La enfermedad carotídea aterosclerosa (ECA) es un factor de riesgo importante para enfermedad vascular cerebral. Objetivo: Analizar la asociación entre factores de riesgo vascular mayores con ECA y leucopatía cerebral en pacientes sin historia de ictus isquémico. Método: Se evaluaron factores de riesgo en sujetos con exploración de carótidas mediante ultrasonografía Doppler dúplex. No se incluyeron casos con historia de infarto cerebral o ataque isquémico transitorio. Los sujetos contaron con resonancia magnética cerebral y se excluyeron aquellos con lesiones isquémicas de grandes vasos. Se construyeron modelos multivariable para la predicción de ECA, estenosis carotídea significativa, carga de ateromas y leucopatía cerebral. Resultados: Se estudiaron 145 sujetos (60.7 % mujeres, edad de 73 años). Se documentó ECA en 54.5 %, estenosis carotídea ≥ 50 % en 9 %, carga de placas de ateroma > 6 en 7.6 % y leucopatía periventricular o subcortical en 28.3 % (20.6 % tenían concurrentemente ECA y leucopatía). Los factores asociados independientemente con ECA fueron edad e hipertensión; con estenosis ≥ 50 %, hipertensión; con cargas de ateromas > 6 placas, edad; con leucopatía, edad, diabetes e hipertensión. La obesidad no se asoció con las variables independientes analizadas. Conclusiones: En los sujetos asintomáticos sin historia de ictus isquémico, la edad y la hipertensión fueron los factores de riesgo más importantes para enfermedad macrovascular. La diabetes mellitus se asoció con enfermedad microvascular. La obesidad por sí sola no fue un determinante mayor de ECA o leucopatía cerebral.
Abstract Introduction: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/epidemiología , Estenosis Carotídea/epidemiología , Leucoencefalopatías/epidemiología , Placa Aterosclerótica/epidemiología , Imagen por Resonancia Magnética , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Factores de Edad , Estenosis Carotídea/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Diabetes Mellitus/epidemiología , Placa Aterosclerótica/diagnóstico por imagen , Hipertensión/complicaciones , Obesidad/epidemiologíaRESUMEN
INTRODUCTION: The purpose of this study was to explore the presence of neuropsychiatric disorders in patients with neurocysticercosis (NCC). METHOD: Patients with untreated NCC (n = 45) and healthy controls (n = 45) underwent psychiatric and neuropsychological assessments. RESULTS: The majority of patients in the NCC group (64.4%) had at least 1 psychiatric diagnosis, compared with a minority in the control group (31.1%). The frequency of neurocognitive disorders, and particularly dementia (major neurocognitive disorder), was significantly higher in the group of patients with NCC. DISCUSSION: This study confirms the relationship between NCC and cognitive disorders.
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Trastornos del Conocimiento/epidemiología , Demencia/epidemiología , Trastornos Mentales/epidemiología , Neurocisticercosis/epidemiología , Adulto , Estudios de Casos y Controles , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCTION: Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity. OBJECTIVE: The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City. METHODS: We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle. RESULTS: From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336). CONCLUSIONS: Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Retina/tratamiento farmacológico , Retinoblastoma/tratamiento farmacológico , Terapia Recuperativa/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Inyecciones Intraarteriales , Estudios Longitudinales , Masculino , Melfalán/administración & dosificación , México , Arteria Oftálmica , Estudios Prospectivos , Neoplasias de la Retina/patología , Retinoblastoma/patología , Topotecan/administración & dosificación , Resultado del TratamientoRESUMEN
Objective: Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality. Methods: From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study. Results: Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n = 8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n = 7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p = 0.005) and moderate to severe cerebral edema were more frequent (p = 0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p = 0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%). Conclusions: In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality.
Objetivo: Las complicaciones cardíacas por endocarditis infecciosa (EI) se presentan en casi 50% de los casos y pueden presentarse complicaciones generalizadas. El interés del estudio fue determinar las características de los pacientes hospitalizados con EI que presentaron complicaciones neurológicas agudas y factores asociados a mortalidad temprana. Métodos: Revisamos expedientes y estudios de imagen desde enero del 2004 hasta mayo del 2010 de todos los pacientes con EI y complicaciones neurológicas evaluadas con tomografía computarizada o resonancia magnética durante la primera semana después de la complicación. El estudio fue descriptivo y retrolectivo. Resultados: De 325 casos con EI, incluimos 35 (10.7%) [varones 19 (54%), media 44 años]. La cardiopatía subyacente más frecuente fue valvulopatía reumática (n = 8, 22.8%). Veinte pacientes sobrevivieron (57.2%, grupo A) y 15 fallecieron (42.8%, grupo B) durante su hospitalización. La principal causa de muerte fue choque séptico (n = 7, 20%). No hubo significado estadístico entre ambos grupos independientemente de presentación clínica, tamaño de vegetación, agente infeccioso o territorio vascular del ACV. La cantidad total de lesiones cerebrales fue mayor en el grupo B (3.1 vs. 1.6, p = 0.005) y el edema cerebral moderado a grave fue más frecuente (p = 0.09). Dieciséis pacientes (45.7%) (12 grupo A y 4 grupo B, p = 0.05) fueron tratados con cirugía cardiaca. Sólo 2 pacientes tuvieron resultados favorables con tratamiento conservador (5.7%). Conclusiones: En pacientes hospitalizados por EI complicada con ACVs, la cantidad de lesiones observadas en estudios de neuroimágen y el tratamiento conservador se asociaron a una mayor tasa de mortalidad intrahospitalaria.
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Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven , Endocarditis/complicaciones , Endocarditis/diagnóstico , Mortalidad Hospitalaria , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Endocarditis , Neuroimagen , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/microbiologíaRESUMEN
OBJECTIVE: Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality. METHODS: From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study. RESULTS: Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n=8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n=7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p=0.005) and moderate to severe cerebral edema were more frequent (p=0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p=0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%). CONCLUSIONS: In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality.
Asunto(s)
Endocarditis/complicaciones , Endocarditis/diagnóstico , Mortalidad Hospitalaria , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Adolescente , Adulto , Anciano , Niño , Preescolar , Endocarditis/diagnóstico por imagen , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neuroimagen , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/microbiología , Ultrasonografía , Adulto JovenRESUMEN
INTRODUCTION: Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. AIM: To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. PATIENTS AND METHODS: We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). RESULTS: The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipidemia, and smoking as factors independently associated with carotid stenosis ≥50%, and hypertension and smoking with symptomatic stenosis. The number of risk factors was strongly associated with the prevalence of carotid stenosis. Notably, neither diabetes nor obesity explained the degree of moderate to severe carotid stenosis. CONCLUSIONS: As forms of carotid atherosclerotic disease, moderate to severe stenosis is less frequent than a high burden of atherosclerotic plaques. Advanced age, smoking, dyslipidemia and hypertension are the main traditional risk factors associated with the degree of carotid stenosis.
TITLE: Caracterizacion de factores asociados con estenosis carotidea en una poblacion de alto riesgo.Introduccion. La estenosis moderada a grave es la forma de enfermedad carotidea aterosclerosa menos prevalente, pero que implica un alto riesgo de ictus isquemico. Objetivo. Caracterizar los factores asociados con la estenosis carotidea moderada a grave en una poblacion de alto riesgo. Pacientes y metodos. Realizamos un analisis de los factores de riesgo tradicionales asociados a estenosis carotidea >= 50% en 533 pacientes que recibieron evaluacion mediante ultrasonograma Doppler por historia de ictus (34%), o que contaban con al menos dos de los factores de riesgo: edad >= 55 años (86%), hipertension (65%), dislipidemia (52%), obesidad (42%), diabetes (40%) o tabaquismo (40%). Resultados. La prevalencia de estenosis carotidea >= 50% fue del 7,1%, sintomatica (asociada a ictus en territorio congruente) en el 5,6%, bilateral en el 2,1% y sintomatica bilateral en el 1,5%. Un 36,8% de los pacientes presento carga moderada a grave (>= 4) de placas de ateroma (25,9%, moderada: 4-6 placas; y 10,9%, grave: >= 7 placas). Mediante analisis multivariable se identifico la edad >= 75 años, la dislipidemia y el tabaquismo como factores asociados con estenosis >= 50%, y la hipertension arterial y el tabaquismo con estenosis sintomatica. El numero de factores de riesgo se asocio fuertemente con la prevalencia de estenosis carotidea. Notablemente, ni la diabetes ni la obesidad explicaron el grado de estenosis moderada a grave. Conclusiones. Como formas de enfermedad carotidea aterosclerosa, la frecuencia de estenosis moderada a grave es menor que una carga alta de placas de ateroma. La edad avanzada, el tabaquismo, la dislipidemia y la hipertension son los principales factores tradicionales que se asocian con el grado de estenosis carotidea.
Asunto(s)
Estenosis Carotídea/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Arteriosclerosis/complicaciones , Arteriosclerosis/diagnóstico por imagen , Arteriosclerosis/epidemiología , Fibrilación Atrial/epidemiología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Comorbilidad , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Fumar/epidemiología , Accidente Cerebrovascular/etiología , Ultrasonografía Doppler de Pulso , Adulto JovenRESUMEN
Autoimmune hypophysitis is a rare condition that must be considered in the differential diagnosis of any pituitary tumor. We present a series of nine patients with clinical and radiologic diagnosis of autoimmune hypophysitis that were admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City between 2000-2012. Clinical, biochemical, imaging features (on MRI), treatment, and follow-up are described, and a review on this disease is presented.
Asunto(s)
Enfermedades Autoinmunes , Enfermedades de la Hipófisis/inmunología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: sacral insufficiency fractures are a cause of debilitating pain in the elderly. These fractures were first described as a clinical entity in 1982. The bone in these patients is structurally weakened and often associated with diseases such as osteoporosis, cancer and immunological processes. This translates into back and pelvic pain unrelated to trauma. These fractures are usually caused by fatigue in most cases. Bone scans and MRI are the imaging studies with the most sensitivity for detecting sacral insufficiency. CLINICAL CASES: two patients with sacral insufficiency fractures who were studied by MRI and bone scan, in whom the diagnosis of sacral insufficiency was made, were treated by sacroplasty. CONCLUSIONS: sacral insufficiency is an underdiagnosed disease, caused by wide range of diseases, mainly osteoporosis. The studies of choice for diagnosis are MRI and bone scans. Techniques, such as percutaneous sacroplasty, produce significant improvements in pain scores and seem a suitable alternative for managing this disease.
Asunto(s)
Fracturas por Estrés/complicaciones , Dolor de la Región Lumbar/etiología , Sacro/lesiones , Fracturas de la Columna Vertebral/complicaciones , Accidentes por Caídas , Anciano , Enfermedades Óseas Metabólicas/complicaciones , Enfermedades Óseas Metabólicas/diagnóstico , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Femenino , Necrosis de la Cabeza Femoral/complicaciones , Necrosis de la Cabeza Femoral/diagnóstico , Necrosis de la Cabeza Femoral/cirugía , Fracturas Espontáneas/complicaciones , Fracturas Espontáneas/diagnóstico , Fracturas Espontáneas/diagnóstico por imagen , Fracturas por Estrés/diagnóstico , Fracturas por Estrés/diagnóstico por imagen , Fracturas por Estrés/cirugía , Humanos , Imagenología Tridimensional , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Sacro/diagnóstico por imagen , Sacro/cirugía , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Estenosis Espinal/complicaciones , Estenosis Espinal/diagnóstico , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico , Espondilolistesis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , VertebroplastiaRESUMEN
Increased area of the substantia nigra (SN) associated to iron deposition has been proposed as a specific marker for Parkinson's disease (PD). Echogenicity, assessed by transcranial sonography (TCS), has been used to measure such an iron deposition. On the other hand, ferroxidase activity is known to play a role in brain iron metabolism and thus could be involved in increased SN echogenicity of PD patients. The present study was conducted to search for a possible correlation between both markers: TCS of SN and plasma ferroxidase activity. Twenty-one PD patients and 13 healthy volunteers (HV) were included. Mean SN sonographic areas were 0.31 cm² for PD patients and 0.12 cm² for HV (P < 0.001), while plasma ferroxidase activity was reduced in PD patients (P < 0.001). Interestingly, plasma ferroxidase activity was inversely correlated with the SN size by TCS (R² = 0.31), suggesting a relationship between the two markers.
Asunto(s)
Ceruloplasmina/metabolismo , Enfermedad de Parkinson/diagnóstico por imagen , Sustancia Negra/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Hierro/metabolismo , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/sangre , Enfermedad de Parkinson/metabolismo , Proyectos Piloto , Sustancia Negra/metabolismo , Ultrasonografía Doppler TranscranealRESUMEN
OBJECTIVE AND IMPORTANCE: Vertebrobasilar aneurysms have a risk of rupture ranging from 2.5 to 50% (especially those larger than 7 mm) and a repeat bleeding rate of between 30 and 70%. For this reason, patients with aneurysms larger than 7 mm should be treated. Considering the high complexity of surgical approaches in this area, an increasing number of reported cases are being treated with endovascular therapy. The purpose of this article is to determine the effectiveness and safety of sole stenting bypass in the treatment of three consecutive patients with vertebrobasilar aneurysms. CLINICAL PRESENTATION: Three patients (one woman and two men) with vertebrobasilar junction aneurysms were included in this study. Two of the patients presented with subarachnoid hemorrhage. INTERVENTION: An endovascular procedure was performed under general (two patients) or local (one patient) anesthesia and via a right femoral approach. By use of road map guidance, sole Express (one patient) or Express 2 (two patients) coronary stents (Boston Scientific/Scimed, Maple Grove, MN) were deployed on the diseased vessel. When the stent was in place, an immediate partial thrombosis of the aneurysm was observed, related primarily to an intra-aneurysmal flow pattern modification, possibly facilitated by modification of the angle of the parent vessel. Follow-up angiograms showed complete exclusion of the aneurysms within the circulation. Only one patient presented visual deficit as a thrombotic complication, but it disappeared completely 6 months after treatment. CONCLUSION: The sole stenting bypass technique seems to be a good alternative for the treatment of complex vertebral aneurysms by inducing thrombosis of the aneurysm with preservation of the parent vessel lumen.
Asunto(s)
Prótesis Vascular , Implantación de Prótesis/métodos , Stents , Procedimientos Quirúrgicos Vasculares/métodos , Disección de la Arteria Vertebral/cirugía , Arteria Vertebral/cirugía , Adulto , Femenino , Humanos , Masculino , Radiografía , Resultado del Tratamiento , Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/diagnóstico por imagenRESUMEN
BACKGROUND: Cavernous angiomas represent 9% of the vascular malformations that affect nervous system. The principal mode of onset is cerebral hemorrhage and epilepsy, and can be sporadic of multiple. In the last, there is a familiar factor specially found in Mexician-American. In our Country there is no data of the clinical or demographic characteristics of the disease. The aim of this study is to describe the clinical characteristics and prognosis of 133 patients with cavernous angiomas consecutively attended in the National Institute of Neurology of Mexico City. PATIENTS AND METHODS: Since 1988 we evaluated a total of 146 cases of cavernous angiomas, 133 were confirmed by MRI and included in the analysis of this study. In every case we registered the demographic characteristic, neurological manifestations, and prognosis divided in good o bad outcome, according to the Glasgow outcome scale (1 and > or = 2 respectively). Data were analyzed with descriptive statistics with the Chi square test, and p was set at 0.05 level. RESULTS: The mean age was 34.3 +/- 14.6 years; 50.4% in male. Eighty seven percent were unique, and the principal manifestation was supratentorial in 65%, infratentorial in 24.8%, supra-infratentorial in 6.8%, and spinal in 3.8%. The clinical manifestations were intracerebral hemorrhage in 58.7%, epilepsy in 48.1%, headache in 37.6%, neurological focalization not secondary to hemorrhage in 8.3%, and incidental in 2.3%. The 6 month outcome was good in 80% of patient assessed by the Glasgow outcome scale. CONCLUSIONS: In our serie the mean age or presentation was 34 years old, the mean neurological manifestations were cerebral hemorrhage and epilepsy, and the outcome was good in the majority of the cases.
Asunto(s)
Neoplasias del Sistema Nervioso Central , Hemangioma Cavernoso del Sistema Nervioso Central , Adulto , Neoplasias del Sistema Nervioso Central/diagnóstico , Neoplasias del Sistema Nervioso Central/epidemiología , Femenino , Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico , Hemangioma Cavernoso del Sistema Nervioso Central/epidemiología , Humanos , Masculino , Pronóstico , Distribución por SexoRESUMEN
Cases of sellar involvement of neurocysticercosis (NCC) are rare. Little is known about the mechanisms by which the parasite can compromise the pituitary gland. Although NCC damages sellar structures with direct compression by large cysts, extension through the basal cisterns and third ventricle with focal arachnoiditis can result as an inflammatory response. Evaluation for hypophyseal lesions in patients with NCC may allow for the diagnosis of unexplained loss of visual acuity and hormonal disturbances.