RESUMEN
Hyperhidrosis is caused by a sympathetic dysfunction of the central or peripheral nervous system. Intramedullary spinal cord lesions can be a cause of hyperhidrosis. The authors report a rare case of intramedullary thoracic spinal cord ganglioglioma presenting as hyperhidrosis. This 16-year-old boy presented with abnormal sweating on the right side of the neck, chest, and the right arm that had been occurring for 6 years. Neurological examination revealed mild motor weakness of the right lower extremity and slightly decreased sensation in the left lower extremity. Hyperhidrosis was observed in the right C3-T8 dermatomes. Magnetic resonance imaging showed an intramedullary tumor at the right side of the spinal cord at the T2-3 level. The tumor showed partial enhancement after Gd administration. The patient underwent removal of the tumor via hemilaminectomy of T2-3. Only subtotal resection was achieved because the margins of the tumor were unclear. Histopathological examination revealed ganglioglioma. Hyperhidrosis gradually improved after surgery. Hyperhidrosis is a rare clinical manifestation of intramedullary spinal cord tumors, and only a few cases have been reported in the literature. The location of the tumor origin, around the right gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Physicians should examine the spinal cord using MRI studies when a patient has hyperhidrosis with some motor or sensory symptoms of the extremities.
Asunto(s)
Ganglioglioma/complicaciones , Hiperhidrosis/etiología , Neoplasias de la Médula Espinal/complicaciones , Adolescente , Ganglioglioma/patología , Ganglioglioma/cirugía , Humanos , Hiperhidrosis/patología , Hiperhidrosis/cirugía , Imagen por Resonancia Magnética , Masculino , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/cirugía , Resultado del TratamientoRESUMEN
A 60-year-old female presented with sudden onset of severe headache and back pain, followed by nausea. The initial head computed tomography (CT) scan revealed posterior fossa subarachnoid hemorrhage (SAH). Spinal T(2)-weighted magnetic resonance imaging demonstrated SAH, and a homogeneous and slightly low signal intensity mass at T11. Spinal angiography in the early arterial phase revealed a small pearl and string-like aneurysm of the proximal radiculomedullary artery on the left side at the T12 level. Forty days after the onset of SAH, CT angiography demonstrated complete occlusion of the dissecting aneurysm and the preserved anterior spinal artery. The present case of ruptured dissecting aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with SAH underwent subsequent spontaneous occlusion, indicating that the wait-and-see strategy may be justified and will provide adequate treatment.
Asunto(s)
Aneurisma Roto/diagnóstico , Disección Aórtica/patología , Arterias/fisiopatología , Médula Espinal/irrigación sanguínea , Hemorragia Subaracnoidea/diagnóstico , Disección Aórtica/complicaciones , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Aorta Abdominal/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Recuperación de la Función/fisiología , Hemorragia Subaracnoidea/etiología , Vértebras Torácicas/irrigación sanguínea , Tomografía Computarizada por Rayos XRESUMEN
A 47-year-old woman underwent decompressive suboccipital craniectomy and C1 laminectomy with duroplasty in the prone position for Chiari malformation type I and syringomyelia. The arachnoid membrane was not injured. Intraoperative echography showed good enlargement of the subarachnoid space. No closed subcutaneous drain was used. The patient complained of repeated nausea and vomiting 3 hours after the operation, and computed tomography revealed remote cerebellar hemorrhage on postoperative day 1. The cerebellar hemorrhage was treated conservatively, and the symptoms continued only for 3 days after surgery. Dural opening with rapid loss of cerebrospinal fluid (CSF) has occurred in every reported case of remote cerebellar hemorrhage complicating intracranial and spinal procedures. Loss of CSF is the main pathogenesis of this condition. In our case, the most probable pathomechanism seems to involve stretching of the infratentorial cerebellar bridging veins due to cerebellar sagging because of dural opening in the prone position and drop in CSF pressure. Such a complication is rare but should be considered after foramen magnum decompression surgery if the patient shows unusual symptoms of repeated vomiting.
Asunto(s)
Malformación de Arnold-Chiari/cirugía , Enfermedades Cerebelosas/fisiopatología , Craneotomía/efectos adversos , Descompresión Quirúrgica/efectos adversos , Foramen Magno/cirugía , Hemorragias Intracraneales/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Enfermedades Cerebelosas/etiología , Enfermedades Cerebelosas/patología , Craneotomía/métodos , Descompresión Quirúrgica/métodos , Femenino , Foramen Magno/anomalías , Humanos , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/patología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patologíaRESUMEN
BACKGROUND AND IMPORTANCE: In surgery of spinal vascular lesions such as spinal arteriovenous fistula or vascular tumors, assessment of feeding arteries and draining veins is important. Intraoperative digital subtraction angiography is useful but is invasive and sometimes technically demanding. Near-infrared indocyanine green (ICG) videoangiography is less invasive and has been reported as an intraoperative diagnosis of arterial patency during clipping surgery of cerebral aneurysms or bypass surgeries. We present our experience with intraoperative ICG videoangiography in 3 cases of spinal vascular lesions. CLINICAL PRESENTATION: Two patients had spinal arteriovenous fistula (perimedullary, n = 1; dural, n = 1), and 1 patient had spinal cord hemangioblastoma at the thoracic or thoracolumbar level. The surgical microscope was an OPMI Pentero (Carl Zeiss, Oberkochen, Germany). After laminectomy and opening of the dura, ICG (5 mg) was injected intravenously. The ICG angiography clearly demonstrated feeding and draining vessels. The ICG findings greatly helped successful interruption of arteriovenous fistula and total removal of the tumor. CONCLUSION: Intraoperative ICG videoangiography for spinal vascular lesions was useful by providing information on vascular dynamics directly. However, the diagnostic area is limited to the field of the surgical microscope. Although intraoperative digital subtraction angiography is still needed in cases of complex spinal vascular lesions, ICG videoangiography will be an important diagnostic modality in the field of spinal vascular surgeries.
Asunto(s)
Verde de Indocianina , Monitoreo Intraoperatorio/métodos , Enfermedades de la Médula Espinal/diagnóstico , Adulto , Humanos , Laminectomía/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Grabación de Videodisco/métodosRESUMEN
BACKGROUND: Couinaud's segmentation is widely used for clinical segmentation of the liver. Recently, a new method of liver segmentation was described by Ryu. In this method, the right posterior sector in Couinaud's segmentation is regarded as 1 segment, and the right anterior sector is subdivided into the antero-ventral segment (AVS) and the antero-dorsal segment (ADS), which are demarcated by the anterior fissure vein (AFV). We used data from multi-detector row computed tomography (MDCT) to identify the portal and hepatic veins that are used as anatomical landmarks in both Couinaud's segmentation and Ryu's segmentation. METHODS: We analyzed data from 100 patients who had no space occupying lesions of the liver and had undergone abdominal CT examination from June through September 2008. MDCT was used to obtain contrast-enhanced helical scans of the whole liver during the portal venous phase. Using thin-slice data, we attempted to identify the portal and hepatic veins, in particular the anterior fissure vein (AFV), the antero-ventral portal vein (AVPV), and the antero-dorsal portal vein (ADPV), all of which are used in Ryu's segmentation. RESULTS: In all cases, we were able to identify the hepatic segments of Couinaud's segmentation. However, in several cases, we were unable to identify the segments used in Ryu's segmentation. The AFV flowed into the intermediate hepatic vein (IHV) in 88% of cases and into the right hepatic vein (RHV) in 12%. Among the former, the AFV flowed into the proximal IHV in 53% of cases. Although the AFV could be identified in these cases, it was difficult to determine the border between the AVS and the ADS. CONCLUSIONS: Our findings indicate that the use of MDCT data to identify hepatic anatomy was more difficult in Ryu's segmentation than in Couinaud's segmentation, because the AFV could not be easily identified in the former. Indeed, even when the AFV could be identified, its use as a landmark was often questionable.
Asunto(s)
Hígado/patología , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
We report a case of a 61-year-old man with ankylosing spondylitis who showed cervical spine fracture. The patient had fallen down on the floor and presented with severe neck pain. He was treated conservatively with a hard neck collar in an emergency hospital because of C7 body fracture without dislocation. However, the follow-up radiographs demonstrated a progressive C6-7 anterior dislocation. He was referred to our hospital 6 weeks after the trauma. The 3D-CT reconstruction imaging revealed that the fracture extended from the C7 vertebral body to the C6 lamina via the bilateral C6/7 facet joints. The patient underwent C2-Th3 posterior fixation using pedicle and lateral mass screw techniques. The postoperative course was uneventful. He was discharged without any complication at 1 month postoperatively. The radiograph 3 months after surgery showed good bone fusion. Spine fracture with ankylosing spondylitis usually shows significant instability because of the long lever-arm of the fused vertebrae at the fracture level. Solid spinal fusions such as long posterior fusion or anterior-posterior simultaneous fusion are needed in such cases.
Asunto(s)
Vértebras Cervicales/lesiones , Fracturas Óseas/cirugía , Espondilitis Anquilosante/complicaciones , Vértebras Cervicales/diagnóstico por imagen , Humanos , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Fusión Vertebral , Espondilitis Anquilosante/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Isolated angiitis of the central nervous system (IAC) is an inflammatory, rare vasculopathy confined to the central nervous system, and the exact etiology has remained uncertain. We report serial changes in the vasculature and the mean cerebral blood flow (mCBF) in two patients with IAC. The first patient, a 58-year-old female, had sudden onset of severe headache and CT 4 days later showed cerebral hemorrhage in the frontal lobe. MRA revealed that the main trunks were dilated on admission, whereas two weeks later, diffuse narrowing of affected arteries occurred in multiple vascular distributions. She required about two months for almost full recovery in MRA findings. Mean CBF during the period of vascular narrowing did not correlate with the form of vasculature, and was much the same as that in the chronic phase. The second patient, a 24-year-old female, presented with severe headache one day after delivery following an uncomplicated pregnancy. MRA findings showed that, at first, segmental stenoses were located only in the peripheral regions of the middle cerebral artery, but this vascular abnormality spread to the anterior, middle and posterior cerebral arteries. She showed almost full recovery in MRA findings after about 3 months. SPECT analysis showed approximately 35% decrease in mCBF compared with that in the chronic phase. In the first case, hyperemia, which was caused by inflammatory cells infiltrating into the brain parenchyma through the vessel wall, contributed to cerebral hemorrhage. On the other hand, in the second case it was presumed that because inflammation was restricted to the vascular wall, mCBF consequently correlated with the form of vasculature. Our experience suggests that IAC has several etiologies.
Asunto(s)
Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Vasculitis del Sistema Nervioso Central/patología , Adulto , Femenino , Humanos , Yofetamina , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Vasculitis del Sistema Nervioso Central/diagnóstico por imagen , Vasculitis del Sistema Nervioso Central/fisiopatologíaRESUMEN
Lacunar infarctions are small lesions caused by occlusion of the deep and penetrating vessels. Occlusion of such vessels are resulted from thrombosis based on atherosclerotic change. However, we occasionally encounter a patient with lacunar infarction seemed to be caused by embolic mechanism, as who has had previous experience of TIA or presented with clinical symptoms suddenly. Diffusion-weighted imaging (DWI) has high accuracy for depicting small ischemic lesions and discrimination of recent infarctions from old ones. We studied frequency, risk factors and stroke mechanism in the territory of penetrating arteries detected on DWI, and sensitivity of ischemic lesions by DWI as compared with conventional MRI images. Fifty-three consecutive patients with lacunar infarction in the territory of penetrating arteries who admitted to our hospital and were studied by DWI within 24 hours. Nine (17.0%) of 53 patients had multiple high signal lesions on DWI. These lesions were found in single arterial territory in 4 patients and in more than 2 territories in 5 patients. It was presumed that stroke mechanisms were artery to artery or cardiogenic embolism. DWI revealed all 38 hyperintensity lesions, while conventional MRI revealed 35 lesions, although the latter was resulted from retrospectively referring to the DWI finding. Therefore, conventional MRI alone might have been difficult to detect multiple lesions. DWI was enable to distinguish embolic infarction from small vessel lacunar infarction, leading to feasible patient management. Therefore, DWI should be performed in all patients with lacunar infarction, even if neurological finding is correspondent with the conventional MRI finding.
Asunto(s)
Infarto Encefálico/diagnóstico , Infarto Cerebral/diagnóstico , Imagen de Difusión por Resonancia Magnética , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Isolated angiitis of the central nervous system (IAC) is an idiopathic type of vasculitis, exclusively affecting small to medium-sized blood vessels of the central nervous system. We report serial angiographical findings, mainly demonstrated with magnetic resonance angiography (MRA) in a case of IAC. A 58-year-old-female came to our hospital because of a sudden headache. Computed tomography (CT) did not show any particular findings. MRA 3 days after the onset revealed diffuse arterial dilatations and segmental stenoses of the middle and anterior cerebral arteries. However, these findings did not lead us to make a diagnosis of IAC. Two days later she was admitted with increased headache and subcortical hemorrhage in the left frontal lobe on CT. Subsequent MRA demonstrated remarkable changes such as dilatated main trunks with segmental stenoses. Steroid pulse therapy was started after definite diagnosis of IAC. She improved gradually and was headache-free 15 days after the onset. Nevertheless, follow-up MRA at 15 days revealed diffusely narrowed anterior and middle cerebral arteries with multiple segmental stenoses. Characteristic findings of angiitis showed improvement at 29 days and had disappeared at 73 days. The patient discontinued corticosteroids and has remained free from headache for the last 7 months.
Asunto(s)
Angiografía por Resonancia Magnética , Vasculitis del Sistema Nervioso Central/diagnóstico , Hemorragia Cerebral/etiología , Femenino , Cefalea/etiología , Humanos , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Monitoreo Fisiológico , Prednisolona/administración & dosificación , Quimioterapia por Pulso , Resultado del Tratamiento , Vasculitis del Sistema Nervioso Central/complicaciones , Vasculitis del Sistema Nervioso Central/tratamiento farmacológicoRESUMEN
Brainstem encephalitis is a rare form of encephalitis which should be differentiated from cerebrovascular and neoplastic diseases. The authors report a case of viral brainstem encephalitis mimicking malignant lymphoma. A 55-year-old female was admitted to our hospital with gradually progressive diplopia and left hemiplegia. CT scan revealed low density lesions in the right globus pallidus and the anterior limb of the internal capsule. MRI demonstrated high intensity signals extending into the right cerebral peduncle, temporal lobe, thalamus and the contralateral thalamus on FLAIR images. Petechial hemorrhages were seen in the affected lesions, but no enhancement was observed following administration of a contrast material. CSF examination revealed mild mononuclear cell dominant pleocytosis. Both early and delayed images of 123I-IMP SPECT revealed marked hot spots corresponding to the lesions on FLAIR images. CT-guided stereotactic biopsy was useful for early diagnosis.