RESUMEN
The authors report a complication of catheter ablation that, to their knowledge, has never been previously reported. A 63-year-old man had undergone successful transvenous catheter thermoablation for atrial fibrillation. The patient remained well until 3 days prior to further admission when he noticed itching in the right frontal area of his scalp. On palpating his scalp, he discovered a metallic body projecting out of it and he proceeded to extract 20 cm of wire from his head. The following day a progressive left hemiplegia developed, and the patient experienced a deteriorating level of consciousness. A CT scan of the brain showed a right frontotemporal intraparenchymal hemorrhage and revealed a metallic structure in the middle of the hematoma. The hematoma was evacuated and a decompressive craniotomy was performed. The guidewire was identified, but it was only possible to extract part of it. It was covered by fibrous tissue, secondary to inflammatory reaction. To the authors' knowledge, this is the first report of guidewire-induced brain hemorrhage. The guidewire apparently had not been removed and had spontaneously migrated from the heart to the brain and beyond to the scalp where it then exited the patient's head. The patient had been well before he attempted to pull out the wire. Earlier identification of the iatrogenic complication of a retained guidewire might have prevented the fatal outcome in this case.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Ablación por Catéter/instrumentación , Hemorragia Cerebral/etiología , Migración de Cuerpo Extraño/diagnóstico , Migración de Cuerpo Extraño/etiología , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Resultado Fatal , Migración de Cuerpo Extraño/terapia , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana EdadRESUMEN
Discal cysts are rare lesions and uncommon causes of low back pain and radiculopathy. Despite growing evidence regarding the clinical, pathological and radiological presentation of these lesions, we do not yet have a detailed understanding of their natural history, etiology or pathogenesis. To our knowledge this is the first report of multiple and multilevel discal cysts, and possible mechanisms of pathogenesis are proposed.