RESUMO
We report a case of epidermal (or epidermoid) cyst, in a 36-year-old man which developed in the third ventricle. Clinical manifestations were headaches and memory disturbances. On CT scan the tumor occupied the entire third ventricle but was mainly developed on the left side. On CT reconstructed images, the floor of the third ventricle was clearly visible. Using a trans-ventricular approach, the tumor, closely related to the left part of hypothalamus, was totally removed. Later on, because of persistent hydrocephalus, a ventricular shunt was inserted. An aseptic meningitis occurred and resolved spontaneously. The patient exhibited a postoperative transitory Korsakoff's syndrome. Postoperative endocrine investigations showed hypopituitarism. Some intra-ventricular epidermal cysts have been reported, especially involving the fourth ventricle. Their development into the third ventricle is unusual, and in early reports their precise origin appears doubtful. Although they have no characteristic radiological features, the location of epidermal cysts is clearly defined by the CT scan and especially MRI. It would be possible to totally remove epidermal cysts of the third ventricle, avoiding the risk of recurrence.
Assuntos
Ventrículos Cerebrais/cirurgia , Cisto Epidérmico/cirurgia , Adulto , Animais , Ventrículos Cerebrais/patologia , Ventriculografia Cerebral , Cisto Epidérmico/diagnóstico , Humanos , Hipotálamo/cirurgia , Imageamento por Ressonância Magnética , Masculino , Camundongos , Tomografia Computadorizada por Raios XRESUMO
A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic treatment was then performed using transvenous catheterization and instillation of Urokinase (2.6 MU over 4 days). A near complete repermeabilization of the sinuses was obtained and the patient improved dramatically in a few days. The only adverse effect of Urokinase was hematuria. Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relatively safe procedure. This treatment should be considered in a patient with extensive dural sinus thrombosis which fails to respond to heparin treatment.
Assuntos
Embolia e Trombose Intracraniana/tratamento farmacológico , Ativadores de Plasminogênio/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Adulto , Cateterismo Periférico , Resistência a Medicamentos , Heparina , Humanos , Injeções , Masculino , Terapia TrombolíticaRESUMO
The radiological appearances in 16 Antilles patients with Blount's disease are described, and a classification is proposed according to the modifications noted during the course of the disease. Six stages can be identified during growth. A decisive stage appears to be that of stage IV when spontaneous epiphysiodesis occurs in the internal part of the epiphysial cartilage. Corrective osteotomy at this stage is always followed by recurrence of the tibia varum. The results of arthrography are defined as well as possible associated pathological affections.