RESUMO

SUMMARY: The aim of this study was to compare the clinical value of vertebral artery ultrasound (VAU), Magnetic Resonance Angiography (MRA) and Digital Subtraction Angiography (DSA) on vertebral artery stenosis in patients with posterior circulation ischemia. Seventy-three patients with posterior circulation ischemia underwent vertebral artery ultrasound and magnetic resonance angiography as well as digital subtraction angiography, and the diagnosis of vertebral artery stenosis (VAS) and the degree of stenosis (normal, mild stenosis, moderate stenosis, severe stenosis, and occlusion) were recorded and compared between digital subtraction angiogram and vertebral artery ultrasound and magnetic resonance angiography. The vertebral artery stenosis rates on digital subtraction angiography and vertebral artery ultrasound were 87.30 % (55/63) and 49.20 % (31/63), respectively, and the difference was statistically significant. The rates of vertebral artery stenosis on digital subtraction angiography and, magnetic resonance angiography was 90.38 % (47/52) and 88.46 % (46/ 52), respectively, and the differences was not statistically significant. The sensitivity, accuracy, negative predictive value, and positive predictive value of vertebral artery ultrasound in diagnosing vertebral artery stenosis were 51.35 %, 54.76 %, 18.18 %, and 95.00 %, respectively, lower than those of magnetic resonance angiography, which were 91.89 %, 90.48 %, 57.14 %, and 97.14 %, respectively. Of the noninvasive imaging techniques, vertebral artery ultrasound does not accurately characterize vertebral artery stenosis and its degree of stenosis. Magnetic resonance angiography effectively screens for vertebral artery stenosis and its degree of stenosis, and can be used as a reliable tool for vertebral artery stenosis in posterior circulation cerebral infarction, and can be used in conjunction with digital subtraction angiogram in order to improve diagnostic convenience and accuracy.

El objetivo de este estudio fue comparar el valor clínico de la ecografía de la arteria vertebral (VAU), la angiografía por resonancia magnética (ARM) y la angiografía por sustracción digital (DSA) en la estenosis de la arteria vertebral en pacientes con isquemia de la circulación posterior. A 73 pacientes con isquemia de la circulación posterior se les realizó una ecografía de la arteria vertebral y una angiografía por resonancia magnética, así como una angiografía por sustracción digital, y se les diagnosticó estenosis de la arteria vertebral (EVA) y el grado de estenosis (normal, estenosis leve, estenosis moderada, estenosis grave, y oclusión) se registraron y compararon la angiografía por sustracción digital y la ecografía de la arteria vertebral y la angiografía por resonancia magnética. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la ecografía de la arteria vertebral fueron del 87,30 % (55/63) y del 49,20 % (31/63), respectivamente, y la diferencia fue estadísticamente significativa. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la angiografía por resonancia magnética fueron del 90,38 % (47/52) y del 88,46 % (46/52), respectivamente, y las diferencias no fueron estadísticamente significativas. La sensibilidad, precisión, valor predictivo negativo y valor predictivo positivo de la ecografía de la arteria vertebral en el diagnóstico de estenosis de la arteria vertebral fueron 51,35 %, 54,76 %, 18,18 % y 95,00 %, respectivamente, inferiores a los de la angiografía por resonancia magnética, que fueron 91,89 %, 90,48 %, 57,14 % y 97,14 %, respectivamente. De las técnicas de imagen no invasivas, la ecografía de la arteria vertebral no caracteriza con precisión la estenosis de la arteria vertebral y su grado de estenosis. La angiografía por resonancia magnética detecta eficazmente la estenosis de la arteria vertebral y su grado de estenosis, y puede usarse como una herramienta confiable para la estenosis de la arteria vertebral en el infarto cerebral de circulación posterior, y puede ser utilizada junto con la angiografía por sustracción digital para mejorar el diagnóstico y la exactitud.

Assuntos

RESUMO

PURPOSE: Diagnostic cerebral digital subtraction angiography (DSA) is an invasive examination that involves catheterization of the major supra-aortic arterial trunks and evaluation of intracranial vessels for diagnostic purposes. Although considered the gold standard method for investigating cerebrovascular diseases, DSA carries measurable and potentially serious complication rates. This report describes the frequency of neurological and non-neurological complications of DSA performed in five hospitals in the state of São Paulo, Brazil, and analyzes them in different disease subgroups. It has a special focus on thromboembolic cerebral complications. METHODS: We retrospectively reviewed clinical records of all adult patients who underwent DSAs between January 2019 and December 2022. Demographic variables, DSA reports, CT/MRI reports, and clinical follow-up notes were reviewed. RESULTS: Twenty-four patients experienced some type of complication among 2,457 diagnostic DSAs (0.97%). Thromboembolic complications were recorded in 9 patients (0.36%), and access site hematomas larger than 5 cm were registered in six patients (0.24%). There was a statistical trend for thromboembolic complications in patients with cervical and/or intracranial atherosclerosis (p = 0.07), but age was not associated with them (p = 0.93). Patients who received heparin had lower rates of embolic complications than those who did not receive it, but there was no statistically significant difference (p = 0.17). Intravenous administration of heparin showed a trend toward significance with groin hematoma (p = 0.10). CONCLUSION: Diagnostic catheter DSAs have low complication rates.

Assuntos

RESUMO

SUMMARY: This study aimed to compare the clinical value of carotid ultrasound and digital subtraction angiography (DSA) for carotid artery stenosis in patients with cerebral infarction. Sixty patients with cerebral infarction underwent carotid ultrasound and DSA. Carotid artery stenosis, degree of stenosis (mild, moderate, severe, and occlusion), and carotid artery plaques were recorded and compared. Carotid stenosis rate was 96.67 % (58/60) and 91.67 % (55/60) on DSA and carotid ultrasound, respectively, and the difference was not statistically significant. Mild, moderate, and severe carotid artery stenosis and occlusion were diagnosed in 35, 28, 20, and 17 arteries, respectively, with DSA, and in 39, 25, 10, and 9 arteries, respectively, with carotid ultrasound. There was a statistically significant difference in the degree of carotid stenosis between the two methods (p<0.05). The kappa value of carotid plaques detected by carotid ultrasound and DSA was 0.776, indicating good consistency. Both carotid ultrasound and DSA are effective for screening carotid artery stenosis and carotid atherosclerotic plaques. While carotid ultrasound is faster and more convenient, DSA can more accurately detect the degree of stenosis and presence of occlusion. Thus, our recommendation is a combination of carotid ultrasound and DSA in clinical settings to improve the convenience and accuracy of diagnosis.

Este estudio tuvo como objetivo comparar el valor clínico de la ecografía carotídea y la angiografía por sustracción digital (DSA) para la estenosis de la arteria carótida en pacientes con infarto cerebral. Sesenta pacientes con infarto cerebral fueron sometidos a ecografía carotídea y DSA. Se registraron y compararon la estenosis de la arteria carótida, el grado de estenosis (leve, moderada, grave y oclusión) y las placas de la arteria carótida. La tasa de estenosis carotídea fue del 96,67 % (58/60) y del 91,67 % (55/60) en DSA y ecografía carotídea, respectivamente, y la diferencia no fue estadísticamente significativa. Se diagnosticaron estenosis y oclusión de la arteria carótida leve, moderada y grave en 35, 28, 20 y 17 arterias, respectivamente, con DSA, y en 39, 25, 10 y 9 arterias, respectivamente, con ecografía carotídea. Hubo una diferencia estadísticamente significativa en el grado de estenosis carotídea entre los dos métodos (p<0,05). El valor kappa de las placas carotídeas detectadas por ecografía carotídea y DSA fue de 0,776, lo que indica una buena consistencia. Tanto la ecografía carotídea como la DSA son eficaces para detectar la estenosis de la arteria carótida y las placas ateroscleróticas carotídeas. Si bien la ecografía carotídea es más rápida y conveniente, la DSA puede detectar con mayor precisión el grado de estenosis y la presencia de oclusión. Por lo tanto, nuestra recomendación es una combinación de ecografía carotídea y DSA en entornos clínicos para mejorar la conveniencia y precisión del diagnóstico.

Assuntos

RESUMO

Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.

O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.

RESUMO

Abstract Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.

Resumo O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.

RESUMO

Renovascular hypertension (RVH) is defined as an elevated blood pressure caused by kidney hypoperfusion, generally as a result of anatomic stenosis of the renal artery with consequent activation of the Renin Angiotensin-Aldosterone System. The main causes include genetic and inflammatory disorders, extrinsic compression, and idiopathic alterations. RVH is often asymptomatic and should be suspected in any child with refractory hypertension, especially if other suggestive findings are present, including those with severe hypertension, abdominal bruit, and abrupt fall of glomerular filtration rate after administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. There is a consensus that digital subtraction angiography is the gold standard method for the diagnosis of RVH. Nevertheless, the role of non-invasive imaging studies such as Doppler ultrasound, magnetic resonance angiography, or computed tomographic angiography remains controversial, especially due to limited pediatric evidence. The therapeutic approach should be individualized, and management options include non-surgical pharmacological therapy and revascularization with percutaneous transluminal renal angioplasty (PTRA) or surgery. The prognosis is related to the procedure performed, and PTRA has a higher restenosis rate compared to surgery, although a decreased risk of complications. This review summarizes the causes, physiopathology, diagnosis, treatment, and prognosis of RVH in pediatric patients. Further studies are required to define the best approach for RVH in children.

Assuntos

RESUMO

OBJECTIVES: Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS: Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS: The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION: We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.

Assuntos

RESUMO

Endovascular treatment and prognosis of intracranial aneurysms are based on size and volume, which demand more accurate neuroimaging techniques. Aneurysm volume calculation is important to choose endovascular treatment modalities and packing density calculation. Of all these methods, it remains unknown which one is the most accurate to calculate aneurysm volume. The objective of this study is to compare the accuracy of three angiography-based versus three tomographic-based methods which calculate aneurysm volume. A retrospective study which included patients with ruptured and unruptured cerebral aneurysms diagnosed by angiogram and computed tomography angiography (CTA) was done. The accuracy of each method was assessed with an ellipsoid glass model of known volume, which helped us to adjust variation in volumetric measurements done with AngioSuite© and AngioCalc© softwares (based on angiographic and tomographic images), 3D-rotational angiography and 3D-CTA (tridimensional computed tomography angiography), based on measurements of diameters such as maximal width and maximal height. Descriptive statistics, ANOVA for repetitive samples and t test were used. We included 89 patients (126 saccular intracraneal aneurysms). AngioSuite© software (angiography-based) showed more accuracy compared to other methods in our control model. The geometric system (AngioCalc) based on CTA images was statistically different from all other methods studied. AngioCalc (CTA-based) demonstrated a significant difference compared with other methods hence, it may overestimate volume measurements. AngioSuite

Assuntos

RESUMO

Among the cases of visceral artery aneurysms, those that involve the inferior mesenteric artery are the most uncommon, with a prevalence of <1%. This study reports a giant symptomatic inferior mesenteric artery aneurysm and its endovascular treatment by means of percutaneous embolization with the implantation of pushable coils. After complete occlusion of the aneurysm, adequate maintenance of arterial supply of the left colon and resolution of the symptoms were observed. In the 2-year follow-up, a significant reduction in the aneurysm's volume and maintenance of the clinical condition were observed.

RESUMO

Computed tomographic angiography (CTA) has recently gained popularity as an initial imaging test for spontaneous subarachnoid hemorrhage (SAH). This study evaluated 59 patients presenting aneurysmal SAH who underwent microsurgical clipping based on CTA findings alone and digital subtraction angiography (DSA) at postoperative follow-up. Multiple aneurysms were identified by CTA in 27% of patients and in 10% of patients, DSA identified aneurysms in addition to those diagnosed with CTA. The time between CTA and surgical treatment ranged from 0­4 days. Postoperative DSA revealed that 24% of patients had residual neck. The use of CTA alonemay not be enough to detect small unruptured aneurysms in patients with multiple lesions or aneurysm remnants adjacent to an aneurysm clip. However, the advantages of CTA compared with DSA include its rapidity, reduced invasiveness, and lower cost, which allow us to proceed to ruptured aneurysm repair entirely on the basis of good-quality CTA studies.

Angiotomografia computadorizada (ATC) ganhou popularidade como exame de imagem inicial na hemorragia subaracnoide (HSA). Este estudo retrospectivo, descritivo e observacional, avaliou 59 pacientes com HSA aneurismática. Todos foram submetidos à clipagem microcirúrgica apenas com base na ATC e no seguimento realizou-se avaliação com angiografia digital (AD). Em 27% dos pacientes encontramos múltiplos aneurismas na ATC e 10% tinham outros diferentes aneurismas diagnosticados pela AD. O intervalo entre ATC e tratamento cirúrgico variou de 0­4 dias. AD pós-operatória mostrou 24% dos pacientes com colo residual. A detecção de pequenos aneurismas não rotos em pacientes com múltiplos aneurismas e colo residual pós clipagem cirúrgica continuam a ser um problema quando a ATC é realizada isoladamente. No entanto, as vantagens da ATC incluem sua rapidez, menor invasão e custo, o que nos permite realizar o tratamento cirúrgico de aneurismas rotos apenas com os achados da ATC de boa qualidade.

Assuntos

RESUMO

El Síndrome de Budd-Chiari (SBC) es una entidad poco usual; su incidencia se calcula de uno en cien mil. Consiste en una obstrucción completa o parcial del flujo venoso localizada en cualquier lugar desde las pequeñas venas hepáticas hasta la porción suprahepática de la vena cava inferior. De acuerdo con su etiología puede clasificarse en: primario (cuando la obstrucción se debe a una enfermedad venosa), o secundario (cuando se atribuye a una compresión extrínseca o a la invasión por una lesión que se origina fuera de las venas como neoplasias o quistes). En la mayoría de los casos se presenta como un cuadro de inicio súbito de dolor abdominal, ascitis y hepatomegalia, pudiendo ser asintomático. El diagnóstico definitivo se establece por estudios de imagen; si bien deben solicitarse exámenes básicos de laboratorio y estudios de extensión. Las modalidades de imagen incluyen la ultrasonografía Doppler, la tomografía computarizada, la resonancia magnética y la angiografía por sustracción digital, que es considerada el patrón de oro. La primera medida terapéutica que debe emprenderse en estos pacientes es la anticoagulación con heparina de bajo peso molecular, seguida de antagonistas de vitamina K. La mayoría de los pacientes requieren un enfoque multidisciplinario y un tratamiento escalonado que incluye procedimientos radiológicos, como la aplicación de balones y stents y la inserción de shunts portosistémicos transyugulares intrahepáticos (TIPS), procedimientos quirúrgicos de descomprensión y, por último, trasplante hepático

Budd - Chiari Syndrome (BCS) is a rare entity whose incidence is estimated at one in one hundred thousand. It consists of complete or partial obstruction of venous outflow at any location from the small hepatic veins to the hepatic portion of the inferior vena cava. It can be classified according to its etiology into primary BCS when there is venous obstruction and secondary disease when obstruction is attributed to extrinsic compression or invasion due to a lesion outside of the veins such as neoplasms or cysts. In most cases it presents as sudden onset of abdominal pain, ascites and hepatomegaly, but it may be asymptomatic. A definitive diagnosis is established by imaging, but basic laboratory tests and other studies must also be done. Diagnostic imaging techniques include Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography. The latter is considered to be the gold standard. The first therapeutic measure to be undertaken for these patients is anticoagulation with low molecular weight heparin followed by vitamin K antagonists. Most patients require a multidisciplinary approach and step by step treatment including radiological procedures, balloon enteroscopy, stenting, transjugular intrahepatic portosystemic shunt (TIPS), decompression surgery and finally, liver transplantation

Assuntos

RESUMO

Intracerebral hemorrhage (ICH) is a devastating condition with multiple possible underlying causes. Early diagnosis of ICH associated with a precise diagnostic work-up is mandatory. Clinical signs may give clues to diagnosis but are not reliable enough and imaging remains the cornerstone of management. Noncontrast computed tomography and magnetic resonance imaging (MRI) are highly sensitive for ICH identification. Additionally, MRI may disclose brain parenchymal biomarkers that can contribute to the etiologic diagnosis. Vessel examination should be carried out whenever there is a clinical suspicion of underlying structural lesions, such as vascular malformations or tumors. To date, conventional angiography remains the gold standard to detect intracranial vascular malformations in patients with ICH.

Assuntos

RESUMO

The objective of the present study is to determine origin, entry level to the transverse foramen and diameter according to sex and side through 3D angiographic images of seventy-nine vertebral arteries obtained using DSA imaging method. During radiological evaluation, axial, coronal and sagittal images of the artery were used. Data of our study was uploaded to SPSS 14.0 program and significance test and Mann Whitney-U test of the difference between two means were used to evaluate the data. While 76 of the vertebral arteries (96.2%) were originating from the subclavian artery, 3 of them (3.8%) were directly originating from aortic arch. In 67 of 76 the vertebral arteries originating from the subclavian artery were entering through C6, 6 through C7, 2 through C5 and one through C4 transverse foramen. It was seen that one of 3 the vertebral artery originating from aortic arch was entering through C6, one through C7 and the other through C4 transverse foramen. While the mean diameter of the vertebral artery was 3.88±0.71 mm at the right side (3.99 mm in men, 3.66 mm in women), the mean diameter at the left side was 4.15±1.05 mm (4.23 mm in men, 4.06 mm in women).

El objetivo fue determinar el origen, nivel de entrada y diámetro del foramen transverso, en función del sexo y lado sobre 79 arterias vertebrales a través de imágenes angiográficas 3D utilizando el método de formación de imágenes DSA. Durante la evaluación radiológica, se utilizaron imágenes axiales, coronales y sagitales de la arteria. Los datos se procesaron en el programa SPSS 14.0 con las pruebas U de Mann Whitney y de significancia para evaluar la diferencia entre los datos. Mientras que 76 de las arterias vertebrales (96,2%) se originaron de la arteria subclavia, 3 de ellas (3,8%) lo hicieron directamente desde el arco aórtico. En 67 de 76 arterias vertebrales, se observó el origin en la arteria subclavia a través de C6; 6 a través de C7, 2 a través de C5 y una a través del foramen transverso en C4. El diámetro medio de la arteria vertebral fue 3,88±0,71 mm en el lado derecho (3,99 mm en hombres y 3,66 mm en mujeres) y en el lado izquierdo fue 4,15±1,05 mm (4,23 mm en hombres y 4,06 mm en hombres).

Assuntos

RESUMO

Sixty-four-section multidetector computed tomography angiography (64-SMCTA) is increasingly used for screening and surgical planning of ruptured intracranial aneurysms due to its high sensitivity and positivity and it is less invasive than digital subtraction angiography (DSA). Combination of both is the best tool when diagnosis is inconclusive. Sometimes the use of 64-SMCTA alone may cause interpretation pitfall and unnecessary life-threatening treatment. This case report is about 64-SMCTA interpretation pitfall, a false positive result that occasioned surgery for clipping an intracranial aneurysm which was not found during surgical procedure. The patient survived the life-threatening surgery and she has been doing well over the last two years. A perceptual error and lack of conspicuity due to some limitations of the scanner to disclose a normal anatomic variant were responsible for this false positive. When ever 64-SMCTA renders inconspicuous images, this result must be seen as inconclusive and hence a meticulous differential diagnosis and DSA are required before any surgical planning.

La angiografía mediante tomografía axial computadorizada con multidetectores de 64 secciones (64- SMCTA) se usa cada vez más para el tamizaje y el planeamiento quirúrgico de la ruptura de aneurismas intracraneales, debido a su alta sensibilidad y positividad, y a que es menos invasiva que la angiografía de substracción digital (ASD). La combinación de ambas es la mejor herramienta cuando el diagnóstico es inconcluso. A veces el uso de 64-SMCTA solo, puede causar una interpretación falsamente positiva, llevando así a un tratamiento innecesario que ponga en peligro la vida del paciente. Este reporte de caso trata de una trampa de la interpretación con 64-SMCTA - un resultado falsamente positivo que ocasionó una cirugía para pinzar un aneurisma intracraneal que no se encontró durante el procedimiento quirúrgico. La paciente sobrevivió la riesgosa cirugía, y le ha ido bien en los últimos dos años. Un error de percepción y falta de clara visibilidad a causa de algunas limitaciones del escáner para revelar variantes anatómicas normales, fueron los responsables del falso positivo, es decir, de la falsa alarma. Cuando el 64-SMCTA produce imágenes no suficientemente precisas, el resultado debe considerarse inconcluso, y se requiere entonces un meticuloso diagnóstico diferencial y DSA antes de proseguir a una planificación quirúrgica.

Assuntos

RESUMO

Enfermedad esteno-oclusiva de la porción terminal de las arterias carótidas internas y de sus ramas principales (arteria carótida media y arteria carótida anterior), progresiva, prevalente en el este Asiático (Japón, Corea), muy rara en nuestro país como en el resto del mundo, de causa desconocida. Se manifiesta mas frecuentemente como un accidente cerebrovascular isquémico transitorio o permanente en los niños menores de 10 años y como accidente cerebrovascular hemorrágico en el adulto. El diagnóstico se realiza con la Angiografía Digital Cerebral y el tratamiento consiste en la revascularización cerebral, que mejora el cuadro neurológico y la calidad de vida.`Se presenta el caso de una niña de 3 años de edad con convulsiones, afasia de expresión, lúcida y hemiparesia izquierda, que luego de una franca mejoría vuelve a presentar una semana después, otra crisis más severa con compromiso de conciencia y hemiplejía derecha, cuyo estudio neurorradiológico reveló la imagen típica de volutas de humo de cigarrillo en la base del cerebro, característico de la enfermedad de Moya-Moya e intervenida quirúrgicamente con la revascularización cerebral por medio de la técnica: EncefaloDuroArterioSinangiosis (EDAS), con buen resultado.

Moya-Moya is a progressive steno-occlusive disease of the internal carotid arteries and its major branches (middle cerebral artery, and anterior cerebral artery) whose cause is unknown, and which is reported primarily in east Asia (Japan and Korea) but rare in Paraguay and the rest of the world. In children under age 10, it presents most commonly as a transient or permanent ischemic attack and in adults as a hemorrhagic stroke. Diagnosis is done by digital subtraction cerebral angiography, and treatment consists of cerebral revascularization to improve the neurological profile and quality of life. We present the case of a 3-year old female child with seizures and motor aphasia who was lucid, with left hemiparesis, and who after complete recovery presented again a week later with a more severe attack, with impaired consciousness and right hemiplegia. Radiological study revealed a typical image of swirls of 'cigarette smoke' at the base of the brain that are characteristic of Moya-Moya disease, and who was operated on using encephaloduroarteriosynangiosis (EDAS), with good results.

Assuntos