ABSTRACT
ABSTRACT: Nasal hemorrhage or epistaxis is a common finding in the emergency department. The causes of epistaxis are varied and can be classified as local, systemic or a combination of both. The aim of this study was to report a case of embolization of branches of the maxillary artery for treatment of epistaxis secondary to facial trauma. A 43-year-old man suffered blunt trauma in the frontonasal area as a result of a bicycle accident. It presented with amnesia, severe epistaxis, panfacial edema and nasal deformity. The patient was hypotensive and hypothermic, with evidence of hemorrhagic intracranial. Orotracheal intubation was performed immediately to protect the airways and prevent aspiration of blood to the lower respiratory tract. The occlusion of the artery was successful and was immediately followed by cessation of oronasal bleeding. The patient was discharged after ten days. Arterial embolization should be the gold-standard treatment, which provides a safe and effective alternative for the control of epistaxis.
RESUMEN: La hemorragia nasal o epistaxis es un hallazgo común en el servicio de urgencias. Las causas de la epistaxis son variadas y pueden clasificarse como locales, sistémicas o una combinación. El objetivo de este estudio fuerelatar un caso de embolización de ramas de la arteria maxilar para el tratamiento de epistaxis secundaria a trauma facial. Um hombre de 43 años de edad sufrió traumatismo contuso en la zona frontonasal como consecuencia de un accidente de bicicleta. Se presentaba con amnesia, epistaxis grave, edema panfacial y deformidad nasal. El paciente fue hipotenso y hipotermático, con evidencia de hemorragia intracraneal. La intubación orotraqueal fue realizada inmediatamente para proteger las vías aéreas y evitar la aspiración de sangre para el tracto respiratorio inferior. La oclusión de la arteria fue exitosa y fue seguida inmediatamente por cesación de sangramiento oronasal. El paciente fue dado de alta después de diez días. La embolización arterial debe ser el tratamiento de elección, que proporciona una alternativa segura y eficaz para el control de la epistaxis.
Subject(s)
Humans , Male , Adult , Epistaxis/etiology , Epistaxis/therapy , Embolization, Therapeutic/methods , Brazil , Angiography , Fluoroscopy , Tomography, X-Ray Computed , Hemorrhage , Nasal CavityABSTRACT
Meningiomas are among the most common intracranial primary tumors, and generally have a benign behavior. The incidence of extracranial metastasis of this pathology is low. There are different variants of them, with a wide variety of aggressiveness and potential tometastatic spread. Among themalignant meningiomas (13% of total), the rhabdoid variant is known for its aggressive biological and clinical behavior. It is also known that some histological subtypes are inherently prone to recur or spread, as the latter. In the latest World Health Organization classification, extracranial metastases are not currently considered a pathological criterion for malignancy, and, when present, they are most commonly found in the lung, liver, lymph nodes, and bone. Treatment is usually surgical resection of the metastases, but there is still no consensus about it. Owing to its poor prognosis, the rhabdoid subtype is commonly treated aggressively. Patients are submitted to local radiotherapy to prevent recurrence. Extracranial metastases of meningiomas are rare, but should always be remembered, especially in cases of local recurrence and malignant histology, as the rhabdoid variant. We report one case of extracranial metastases in a patient diagnosed with rhabdoid subtype of meningioma, and discuss the literature on this pathology.
Meningiomas estão entre os tumores intracranianos primários mais comuns, e geralmente possuem comportamento benigno. A incidência de metástases extracranianas desta patologia é baixa. Existem diversas variantes, com uma ampla variedade de agressividade e potencial para disseminação metastática. Entre os meningiomas malignos (13% do total), a variante rabdoide é conhecida por seu comportamento agressivo clínico e biológico. Também é sabido que alguns subtipos histológicos são propensos à recidiva e disseminação, como o supracitado. Na última classificação da Organização Mundial de Saúde, metástases extracranianas não são consideradas como critério patológico para malignidade, e, quando presentes, são geralmente encontradas nos pulmões, fígado, linfonodos e ossos. O tratamento é geralmente a ressecção cirúrgica das metástases, embora não há consenso. Devido ao seu prognóstico pobre, o subtipo rabdoide é comumente tratado de forma agressiva. Os pacientes são submetidos à radioterapia local para prevenção de recidivas. As metástases extracranianas de meningiomas são raras, mas sempre devem ser consideradas, especialmente em casos com recidiva local e histologia maligna, como a variante rabdoide. Relatamos um caso de metástases extracranianas em um paciente com o subtipo rabdoide de meningioma, e discutimos a literatura a seu respeito.