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INTRODUCTION: Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. AIM: To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. METHODS: Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. RESULTS: All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. CONCLUSION: In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.
Assuntos
Angiofibroma/terapia , Embolização Terapêutica/efeitos adversos , Adolescente , Adulto , Angiofibroma/cirurgia , Criança , Terapia Combinada , Humanos , Masculino , Período Pré-Operatório , Adulto JovemRESUMO
Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
Assuntos
Angioplastia , Estenose das Carótidas/patologia , Estenose das Carótidas/terapia , Circulação Cerebrovascular , Imageamento por Ressonância Magnética/métodos , Stents , Idoso , Idoso de 80 Anos ou mais , Volume Sanguíneo , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral , Feminino , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
STUDY DESIGN: A prospective, non-randomized clinical series trial. OBJECTIVE: To evaluate the effect of autogenous undifferentiated stem cell infusion for the treatment of patients with chronic spinal cord injury (SCI) on somatosensory evoked potentials (SSEPs). SETTING: A public tertiary hospital in São Paulo, Brazil. METHODS: Thirty-nine consecutive patients with diagnosed complete cervical and thoracic SCI for at least 2 years and with no cortical response in the SSEP study of the lower limbs were included in the trial. The trial patients underwent peripheral blood stem cell mobilization and collection. The stem cell concentrate was cryopreserved and reinfused through arteriography into the donor patient. The patients were followed up for 2.5 years and submitted to SSEP studies to evaluate the improvement in SSEPs after undifferentiated cell infusion. RESULTS: Twenty-six (66.7%) patients showed recovery of somatosensory evoked response to peripheral stimuli after 2.5 years of follow-up. CONCLUSION: The 2.5-year trial protocol proved to be safe and improved SSEPs in patients with complete SCI. SPONSORSHIP: None.
Assuntos
Vias Aferentes/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Regeneração Nervosa/fisiologia , Transplante de Células-Tronco de Sangue Periférico/métodos , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/cirurgia , Biomarcadores , Separação Celular/métodos , Eletrodiagnóstico/métodos , Eletrofisiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Córtex Somatossensorial/fisiologia , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Células-Tronco/citologia , Células-Tronco/fisiologia , Resultado do TratamentoRESUMO
The aims of this study were to establish Doppler criteria for identifying direct carotid-cavernous fistulae (DCCF), as well as the level of agreement between results obtained by Doppler mapping vs. angiography. Doppler mapping and angiography were used to assess the direction of flow in the superior ophthalmic veins and the resistivity index in the internal carotid arteries of 30 patients with DCCF. Both methods independently demonstrated reverse flow in superior ophthalmic vein ipsilateral to the DCCF in 22 patients and normal flow in another four. The mean resistivity index for internal carotid arteries with ipsilateral DCCF was significantly reduced (p = 0.0001) compared with that for contralateral internal carotid arteries without DCCF. A resistivity index value of 0.495 offered a sensitivity and specificity of 86.6% in diagnosing ipsilateral DCCF. These findings suggest that a resistivity index < 0.495 in the ipsilateral internal carotid artery, with or without reverse flow in the superior ophthalmic vein, is associated with a reasonable probability of diagnosing DCCF.
Assuntos
Fístula Carótido-Cavernosa/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Adolescente , Adulto , Angiografia Digital , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Olho/irrigação sanguínea , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade , Resistência Vascular , Veias/diagnóstico por imagemAssuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Períneo/irrigação sanguínea , Períneo/lesões , Priapismo/etiologia , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Angiografia Digital , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Criança , Cianoacrilatos/uso terapêutico , Hemodinâmica , Humanos , Masculino , Priapismo/classificação , Priapismo/diagnóstico por imagem , Priapismo/fisiopatologia , Resultado do TratamentoRESUMO
INTRODUCTION: Intracranial vertebral artery dissection is a rare condition which may present as subarachnoid hemorrhage. In this situation, treatment is controversial. CASE REPORT: A case of intracranial right vertebral artery dissection in a 55-year-old woman presenting with subarachnoid hemorrhage is reported. The patient underwent therapeutic occlusion of the dissected artery through microcatheterization using pushing detachable platinum microcoils and had a good outcome. At this moment, the patient has a normal neurologic examination and a control digital subtraction angiography 1 year after the procedure showed an occluded right vertebral artery at V3; there was retrograde flow in the right intracranial vertebral artery up to the origin of a meningeal branch; the artery was thin and had mural irregularities, without any evidence of aneurismatic dilatation. DISCUSSION: We review the literature and discuss the role of endovascular therapy and other therapeutic options in the treatment of this condition.
Assuntos
Dissecção Aórtica/diagnóstico por imagem , Angiografia Cerebral , Embolia Intracraniana/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Artéria Vertebral/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
An 8-year-old child was examined because of conductive hearing loss with a retrotympanic mass on otoscopy. CT and MR angiography showed a large inferior tympanic artery traversing the hypotympanum and joining a thin, irregular internal carotid artery with a normal middle meningeal artery. These investigations, coupled with knowledge of the embryological development allowed a diagnosis of a complex vascular anomaly in the middle ear and avoided potential surgical complications.
Assuntos
Artéria Carótida Interna/anormalidades , Orelha Média/diagnóstico por imagem , Orelha Média/patologia , Angiografia por Ressonância Magnética , Tomografia Computadorizada por Raios X , Criança , Feminino , Perda Auditiva Funcional/etiologia , Humanos , Estapédio/irrigação sanguíneaRESUMO
A magnetic resonance imaging (MRI) study of the normal pineal gland and pineal simple cysts was performed in 762 cases. A fine section technique (maximum 3 millimeters) enabled most of the times the identifying of a normal pineal in addition to demonstrating that a pineal without any cyst shows an isointense signal in T1 and T2 which, in turn, is enhanced following gadolinium. The measure of the normal pineal was of about 6.1 millimeters in its diameter length. Pineal simple cysts were observed in a 2.6% frequency in relation to the whole series (762 cases); however reaches 6.1% when only the visualized pineals were considered (329 cases). Also, it was found out that simple cysts were not correlated to age or gender. Simple cysts characteristics are: dimension less or equal to 20 millimeters; absence of expansive effect; similar signal to that of the cerebrospinal fluid; absence of cyst growth.
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Glândula Pineal/anatomia & histologia , Glândula Pineal/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/diagnóstico , Criança , Pré-Escolar , Cistos/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
SUMMARY: A 42-year-old woman presented with headache, galactorrhoea, marked hyperprolactinemia and normal neurologic examination. CT, MR and MR-angiography showed an intracavernous carotid artery aneurysm with minimal displacement of the pituitary stalk. Treatment by embolisation using GDC coils allowed exclusion of the aneurysm. Galactorrhoea resolved and serum prolactin levels fell to normal after eight months. Followup MR showed absence of the aneurysm, although the discrete mass effect persisted, suggesting that hyperprolactinaemia was due to pulsatility.
RESUMO
With the objective of analyzing the postaneurysmal peak systolic velocity (PSV) in ophthalmic arteries, duplex scanning was analyzed in 28 carotid-ophthalmic artery segments after exclusion of ipsilateral carotid stenosis. For comparison, the angiographic study of the extracranial and intracranial carotid system was utilized as the "gold standard." A subgroup of 7 subjects with 8 ophthalmic arteries with aneurysms identified where the artery leaves the internal carotid artery presented with PSVs significantly reduced (mean PSVs 17.95 +/- 7.99 cm/s) compared to the mean PSVs in the healthy group (27.95 +/- 5.54 cm/s) (p = 0.006). A PSV of less than 19 cm/s offered a sensitivity of 80% and a specificity of 100% in diagnosing ophthalmic artery aneurysms. We conclude that duplex scan is diagnostically useful in the identification of patients with ophthalmic artery aneurysms when severe ipsilateral carotid stenosis is excluded.
Assuntos
Aneurisma/diagnóstico por imagem , Artéria Oftálmica/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Adulto , Idoso , Análise de Variância , Aneurisma/complicações , Aneurisma/fisiopatologia , Angiografia , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/diagnóstico por imagem , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
A 56-year-old female with unstable angina, presented an acute embolic ischaemic stroke of right medium cerebral artery during elective coronary angiography. Complete patency was achieved after an intraarterial infusion of rt-PA (60mg/60min) with important functional improvement.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Embolia e Trombose Intracraniana/tratamento farmacológico , Ativadores de Plasminogênio/uso terapêutico , Ativador de Plasminogênio Tecidual/uso terapêutico , Doença Aguda , Cineangiografia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Pessoa de Meia-IdadeRESUMO
Tolosa-Hunt syndrome (THS), or painful ophthalmoplegia is associated to a non-specific granulomatosis of unknown etiology, that involves the superior orbital fissure and its nervous and vascular structures. The clinical picture that responds to steroid therapy, is variable and is always associated with pain. Inflammatory conditions, tumors and aneurysms can produce similar symptoms. Computed tomography, cerebral angiography and orbital phlebography are the imaging methods of choice for making the diagnosis. We revised the results of these radiological examinations of eight patients seen at the Hospital São Paulo from 1989 to 1991, with the diagnosis of THS according to Hunt and Hannerz criteria. The analysis of orbital phlebographic changes based upon Hannerz et al. systematization showed non-specific features, but those were able to help the diagnosis.
Assuntos
Artéria Oftálmica/diagnóstico por imagem , Oftalmoplegia/diagnóstico por imagem , Flebografia , Adulto , Idoso , Angiografia Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Tomografia Computadorizada por Raios XRESUMO
A Síndrome de Tolosa-Hunt (STH) ou oftalmoplegia dolorosa é associada a granulomatose inespecifica de etiologia desconhecida que acomete a fissura orbitária superior. Compromete estruturas nervosas e vasculares causando quadro clínico variável que sempre se associa a dor e apresenta resposta favorável à corticoterapia. Processos inflamatório, tumores e anmeurismas dessa regiäo podem causar sintomas semelhantes. A tomografia computadorizada, a angiografia cerebral e a flebografia orbitária säo métodos de imagem indicados para orientar o diagnóstico. Revisamos os resultados destes exames radiológicos de oito pacientes atendidos no Hospital Säo Paulo no período 1989 a 1991, com diagnóstico de STH segundo os critérios de Hunt e Hannerz. A análise das alteraçöes da flebografia orbitária, de acordo com a sistematizaçäo feita por Hannerz e col. Mostrou ser este exame inespecífico, porém capaz de orientar melhor mo diagnóstico
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Artéria Oftálmica , Oftalmoplegia/diagnóstico , Flebografia , Angiografia Cerebral , Síndrome , Tomografia Computadorizada por Raios XAssuntos
Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hipertensão/fisiopatologia , Verapamil/farmacologia , Animais , Modelos Animais de Doenças , Hipertensão Renal/fisiopatologia , Infusões Parenterais , Masculino , Ratos , Ratos Endogâmicos , Verapamil/administração & dosagemRESUMO
O efeito hipotensor do verapamil foi estudado em animais normais e em portadores de dois modelos experimentais de hipertensao: hipertensao neurogenica aguda e hipertensao renal.Para o estudo foram utilizados ratos acordados, com o proposito de evitar a depressao produzida por anestesia, dos reflexos cardiovasculares que controlam a pressao arterial e a frequencia cardiaca. O verapamil foi injetado, por via venosa, em infusao continua por 30 minutos, nas doses de 4 a 22 ug/min/100g.Os resultados mostraram que a pressao arterial media diminui tanto nos animais normais como nos hipertensos, sendo a hipotensao mais rapida e intensa no grupo de ratos com hipertensao neurologica aguda.A frequencia cardiaca aumentou nos ratos normais e com hipertensao renal devido a hipotensao provocada pelo verapamil. Nos ratos com hipertensao neurogenica aguda, ocorreu bradicardia devido a inatividade dos pressoreceptores evidenciando a acao cronotropica negativa do verapamil. Os resultados obtidos recomendariam seu uso nas crises hipertensivas em pacientes sem depressao de reflexos cardiovasculares