RESUMEN
Pulmonary emboli as a fatal complication of superior sagittal sinus thrombosis was once well recognized in the literature but appears to have been forgotten. The sagittal sinus appeared to be the source of pulmonary emboli in previously reported cases. Even in patients with no evidence of systemic thrombosis, but who have sagittal sinus thrombosis, the possibility of dislodging pulmonary emboli should be strongly considered. We report a case of nontraumatic sagittal sinus thrombosis complicated by multiple pulmonary emboli and a fatal saddle embolism, likely originating from the thrombosed sinus. Our review of the literature between 1942 and 1990 yielded 203 cases of intracranial venous thrombosis. The overall mortality rate was 49.3%. In 23 cases (11.3%), the venous sinus thrombosis was associated with pulmonary emboli and in these the overall mortality rate was 95.6%. In the 203 cases in our review, those patients who received anticoagulation therapy also had a statistically significant better outcome. Therefore, the presence of pulmonary emboli in association with sagittal sinus thrombosis mandates a sober assessment of the need of anticoagulation therapy in the absence of obvious contraindication.
Asunto(s)
Embolia Pulmonar/complicaciones , Trombosis de los Senos Intracraneales/complicaciones , Adulto , Anticonceptivos Orales/administración & dosificación , Anticonceptivos Orales/efectos adversos , Senos Craneales/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Examen Neurológico/efectos de los fármacos , Arteria Pulmonar/patología , Embolia Pulmonar/inducido químicamente , Embolia Pulmonar/patología , Trombosis de los Senos Intracraneales/inducido químicamente , Trombosis de los Senos Intracraneales/patología , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
We describe two patients who developed neuromyotonia of the floor of the mouth after irradiation of a motor branch (V3) of the trigeminal nerve. The neuromyotonia manifested as sustained muscle contraction due to peripheral nerve dysfunction. The neuromyotonia in both patients was controlled with carbamazepine. Radiation-exposed nerves can become symptomatic months or years after completion of radiation therapy.
Asunto(s)
Enfermedades Neuromusculares/etiología , Traumatismos por Radiación/fisiopatología , Nervio Trigémino/efectos de la radiación , Adulto , Anciano , Femenino , Humanos , Enfermedades Neuromusculares/fisiopatología , Factores de Tiempo , Nervio Trigémino/fisiopatologíaRESUMEN
A patient with acute myelocytic leukemia who had a chronic febrile illness during the induction of remission of leukemia developed asymptomatic discrete pulmonary infiltrates which rapidly evolved into cavities containing homogeneous opacities. Over the next five weeks, the cavities resolved without specific treatment. The patient subsequently passed large fungus balls in the urine, and the diagnosis of disseminated aspergillosis was made. A course of intravenous amphotericin B therapy was completed without complications. This case demonstrates the importance of culturing urine specifically for fungal organisms in the immunosuppressed host.