ABSTRACT
During the last five decades, long-term therapy with immunosuppressive agents such as pulse cyclophosphamide in conjunction with high-dose corticosteroids has enhanced both patient survival and renal survival in patients with diffuse proliferative lupus nephritis. Nevertheless, severe side effects such as infectious complications remain the main cause of morbidity and mortality. Central nervous system aspergillosis is uncommon but life-threatening in lupus patients. In this single-patient case study, carotid aneurysm with sphenoidal sinusitis was suspected when severe epistaxis occurred during cyclophosphamide pulse therapy. With anti-fungal therapy, a graft stent was successfully deployed to the aneurysm and specimens of sphenoidal mucosa showed typical hyphae, indicating aspergillosis. Three months after stopping voriconazole treatment, two cerebral aneurysms that were revealed on MR images were successfully removed by aneurysmal clipping. The patient remained alive at one-year follow-up with lupus nephritis in remission. The rarity and high mortality of aspergillus-related fungal aneurysms have led to most cases being recognized postmortem. However, such aneurysms must be diagnosed early to prevent fatal complications by performing appropriate management such as surgical procedure or endovascular intervention.
Subject(s)
Female , Humans , Middle Aged , Antifungal Agents/therapeutic use , Immunosuppressive Agents/adverse effects , Intracranial Aneurysm/drug therapy , Lupus Nephritis/complications , Neuroaspergillosis/drug therapy , Pyrimidines/therapeutic use , Stents , Surgical Instruments , Triazoles/therapeutic useABSTRACT
Relatamos o caso de uma doente de 36 anos que apresentou oclusão de um aneurisma fusiforme de artéria basilar associado a infarto pontino e dois episódios de hemorragia subaracnóide provavelmente devido a dissecção arterial. Ela também apresentava aneurismas fusiformes assintomáticos na artéria cerebral média direita e na artéria carótida interna esquerda. Ao longo de 5 anos, lesões compatíveis com displasia fibromuscular foram observadas na artéria vertebral direita, assim como oclusão da artéria vertebral esquerda. Esta combinação de lesões sugere que um mecanismo etiopatogênico comum tenha causado diferentes graus de comprometimento da camada média de artérias cervicocranianas.
Subject(s)
Adult , Female , Humans , Arterial Occlusive Diseases/complications , Carotid Artery Diseases/complications , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/complications , Ticlopidine/analogs & derivatives , Arterial Occlusive Diseases/drug therapy , Arterial Occlusive Diseases , Aspirin/therapeutic use , Basilar Artery , Carotid Artery, Internal , Cerebral Angiography , Carotid Artery Diseases/drug therapy , Carotid Artery Diseases , Intracranial Aneurysm/drug therapy , Intracranial Aneurysm , Platelet Aggregation Inhibitors/therapeutic use , Subarachnoid Hemorrhage/drug therapy , Subarachnoid Hemorrhage , Ticlopidine/therapeutic useABSTRACT
Infective intracranial aneurysms are relatively uncommon. They develop due to septic embolisation of the vasa vasorum or lumen of the artery, with resultant focal arteritis and necrosis, leading to aneurysm formation. They are an important cause for intracranial haemorrhage. Six cases of infective aneurysms are described. A focus of infection could be detected in all the patients. Surgery was done in three cases, out of which two patients made significant recovery, while one patient died in the immediate postoperative period. Out of the three cases, treated conservatively with antibiotic therapy, there was total resolution on follow up angiogram in two, while one patient was lost to follow up.
Subject(s)
Adolescent , Adult , Aneurysm, Infected/drug therapy , Anti-Bacterial Agents/therapeutic use , Cerebral Angiography , Child , Humans , Intracranial Aneurysm/drug therapy , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Relato de caso de neurofibromatose tipo I associada a doença oclusiva extensa do sistema carotídeo em sua porçao intracraniana e aneurisma fusiforme de circulaçao posterior. O paciente, de 28 anos de idade e com diagnóstico de doença de von Recklinghausen, passou a apresentar episódios de síncope, crises parciais complexas e declínio cognitivo. Após quadro agudo de cefaléia e sinais de irritaçao meníngea, com líquor hemorrágico, o paciente foi investigado com, TC de crânio, RNM e angiografia cerebral, sendo detectadas alteraçoes tipo moyamoya e dilataçao aneurismática de artéria cerebral posterior. Apresentamos os achados clínicos e radiológicos deste caso com poucos relatos similares na literatura médica, discutimos opçoes terapêuticas e reiteramos a inclusao de diagnósticos diferenciais raros em indivíduos que apresentem icto com menos de quarenta anos de idade.
Subject(s)
Humans , Male , Adult , Intracranial Aneurysm/complications , Moyamoya Disease/complications , Neurofibromatosis 1/complications , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/drug therapy , Moyamoya Disease/diagnosis , Moyamoya Disease/drug therapy , Neurofibromatosis 1/diagnosis , Neurofibromatosis 1/drug therapyABSTRACT
Os autores relatam o caso de um paciente com doença de Moya-Moya e aneurisma duplo da artéria basilar. Discutem os aspectos etiopatogênicos, o diagnóstico e a melhor forma de tratamento
Subject(s)
Adult , Humans , Male , Intracranial Aneurysm , Moyamoya Disease , Aminocaproic Acid/therapeutic use , Basilar Artery , Cerebral Angiography , Dexamethasone/therapeutic use , Intracranial Aneurysm/drug therapyABSTRACT
Se presentan 10 pacientes que tenían más de un aneurisma intracraneal siendo el 90% del sexo femenino y la edad más frecuente la 5ta. década. El porcentaje de morbilidad fue de un 10% y el porcentaje de mortalidad de un 0%