Absceso epidural posterolateral y compresión radicular: una rara complicación del absceso retrofaríngeo / Posterolateral epidural abscess and root compression: a rare complication of retropharyngeal abscess

Introducción: el absceso epidural posterolateral y la compresión radicular es una rara complicación del absceso retrofaríngeo (ARF). Se realizó el reporte de un caso con esta complicación extremadamente rara. Método: reporte de caso y revisión de la literatura (estudios radiológicos, historia y hallazgos clínicos). Se firmó consentimiento del paciente para la publicación. Resultados: paciente de 33 años remitido a nivel terciario de atención con un cuadro clínico de cervicalgia, odinofagia y fiebre. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) mostraron una colección retrofaríngea con compromiso epidural en el espacio medular cervical; en el examen físico se encontró odinofagia, cervicalgia, fiebre y pérdida de la fuerza muscular en el miembro superior derecho. El paciente fue llevado a manejo quirúrgico por otorrinolaringología y ortopedia para el drenaje de la colección; además, se le administró antibioticoterapia con cefepime y clindamicina por 21 días con buenos resultados; se consideró que el origen del absceso era idiopático. Conclusiones: el absceso epidural y la compresión radicular secundarias a un ARF es una rara y potencialmente mortal complicación de esta patología, con secuelas importantes en el paciente que la padece, que requiere un manejo médico-quirúrgico. En nuestro caso el manejo fue interdisciplinario, ya que integró otorrinolaringología, ortopedia, infectología y fisioterapia, lo que resultó en una evolución satisfactoria del paciente.

Introduction: posterolateral epidural abscess and radicular compression is a rare complication of retropharyngeal abscess (RFA), a case report with this extremely rare complication was made. Method: case report and review of the literature (radiological studies, clinical history, clinical findings) patient's consent was signed for the publication. Results: a 33-year-old patient referred at the tertiary care level with a clinical picture of cervicalgia, odynophagia and fever; CT and MRI showed retropharyngeal collection with epidural involvement in the cord cervical space, physical examination, odynophagia, cervicalgia, fever and loss of muscle strength in the right upper limb. Led to surgical management by ENT and orthopedics column for drainage of the collection; antibiotic therapy with cefepime, clindamycin for 21 days with good results; It was considered of idiopathic origin. Conclusions: epidural abscess and root compression secondary to an RFA is a rare and potentially fatal complication of this pathology with important sequelae in the patient, which requires medical-surgical management, in our case the management was integrated interdisciplinary otolaryngology, orthopedics, infectology, physiotherapy , with satisfactory evolution in the patient.

An accessory abductor digiti minimi as possible risk factor of the median and ulnar nerves compression / Músculo abductor digiti minimi accesorio como posible factor de riesgo de la compresión de los nervios mediano y ulnar

SUMMARY: During routine dissection of a left upper limb of a 68-year-old male human cadaver, an unusual muscle was observed originating from the radius and flexor retinaculum, and continued in the hypothenar region with the muscle belly of the abductor digiti minimi. We checked that it was an accessory abductor digiti minimi (ADM). Its muscular belly was in close relation to the median and ulnar nerves. We review the literature regarding such muscle variations and discuss the potential for compression of the median and ulnar nerves. Although the accessory ADM is usually asymptomatic and only rarely results in nerve compression, it should be taken into account by surgeons when establishing a differential diagnosis in the compression neuropathies of the median and ulnar nerves. An ultrasound scanning can help establish the differential diagnosis.

RESUMEN: Durante la disección de rutina de un miembro superior izquierdo de un cadáver humano masculino de 68 años, se observó un músculo inusual que se originaba en el radio y el retináculo flexor del carpo, y continuuaba en la región hipotenar con el vientre muscular del abductor digiti minimi manus. Verificamos que se trataba del músculo abductor digiti minimi accessorius (ADMA). Su vientre muscular se encontraba en estrecha relación con los nervios mediano y ulnar. Revisamos la literatura sobre variaciones musculares y discutimos la potencial compresión de los nervios mediano y ulnar. Aunque el ADMA suele ser asintomático y rara vez produce compresión nerviosa, los cirujanos deben tenerlo en cuenta al establecer un diagnóstico diferencial en las neuropatías de compresión de los nervios mediano y ulnar. Una ecografía puede ayudar a establecer el diagnóstico diferencial.

Accessory muscles: a cause of nerve compression in the distal forearm. Case report and literature review / Músculos accesorios: una causa de compresión nerviosa en el antebrazo distal. Reporte de casos y revisión de la Literatura

Nerve compression by anomalous muscles located at the wrist and distal forearm is an infrequent condition. Accessory muscles may compress underlying structures in the Carpal Tunnel region or ulnar canal , producing pain and paresthesia. Two cases of ulnar and median nerve compression, caused by prominent accessory muscles at the distal forearm, are described. Literature review is presented.

La compresión nerviosa causada por vientres musculares anómalos localizados en la muñeca y en el tercio distal del antebrazo es una condición poco frecuente. Músculos accesorios pueden comprimir estructuras subyacentes en la región del túnel del carpo o en el canal de ulnar, produciendo dolor y parestesia. Se presentan dos casos de compresión de los nervios ulnar y mediano en el tercio distal del antebrazo, causados por vientres musculares prominentes de músculos accesorios del antebrazo. Se presenta una revisión de la literatura.

Progressão atípica de perda visual em paciente com glaucoma primário de ângulo aberto / Atypical progression of visual loss in a patient with primary open-angle glaucoma

A dolicoectasia da artéria carótida interna (ACI) é uma condição rara que pode ser acompanhada de manifestações neuro-oftalmológicas, como perda da acuidade e alteração do campo visual decorrente da compressão do nervo óptico (NO). O objetivo é relatar um caso de paciente do sexo masculino, 67 anos, portador de glaucoma primário de ângulo aberto (GPAA) com evolução atípica, assimetria de escavação, palidez da rima do NO à esquerda, devido à neuropatia óptica compressiva à esquerda, por segmento dolicoectásico da ACI. O diagnóstico foi baseado na história clínica, aspecto do NO e exames de neuroimagem.

Dolichoectasia of the internal carotid artery (ICA) is a rare condition that may be associated with neuro-ophthalmic manifestations, such as loss of visual acuity and visual field resulting from compression of the optic nerve (ON). The aim is to report a 67-year-old male patient with primary open-angle glaucoma (POAG) with atypical evolution, asymmetry of cupping and increased pallor of the rim of the left ON, due to compressive optic neuropathy by the dolichoectatic segment. The diagnosis was based on clinical history, appearance of the ON and neuroimaging.

Ortner's syndrome: case series and literature review / Síndrome de Ortner: série de casos e revisão da literatura

More than a century ago, Ortner described a case of cardiovocal syndrome wherein he attributed a case of left vocal fold immobility to compression of the recurrent laryngeal nerve by a dilated left atrium in a patient with mitral valve stenosis. Since then, the term Ortner's syndrome has come to encompass any nonmalignant, cardiac, intrathoracic process that results in embarrassment of either recurrent laryngeal nerve-usually by stretching, pulling, or compression; and causes vocal fold paralysis. Not surprisingly, the left recurrent laryngeal nerve, with its longer course around the aortic arch, is more frequently involved than the right nerve, which passes around the subclavian artery. OBJECTIVES: To discuss the pathogenesis of hoarseness resulting from cardiovascular disorders involving the recurrent laryngeal nerve along with the findings of literature review. MATERIALS AND METHODS: This paper reports a series of four cases of Ortner's syndrome occurring due to different causes. DESIGN: Case study. RESULT: Ortner's syndrome could be a cause of hoarseness of voice in patients with cardiovascular diseases. CONCLUSION: Although hoarseness of voice is frequently encountered in the Otolaryngology outpatient department, cardiovascular- related hoarseness is an unusual presentation. Indirect laryngoscopy should be routinely performed in all cases of heart disease.

Há mais de um século, Ortner descreveu um caso de síndrome cardiovocal, no qual ele atribuiu um caso de imobilidade da prega vocal esquerda à compressão do nervo laríngeo recorrente causada por dilatação do átrio esquerdo em um paciente com estenose valvar mitral. Desde então, o termo Síndrome de Ortner tem sido usado para descrever qualquer condição cardíaca intratorácica não maligna que resulte no envolvimento do nervo laríngeo recorrente - geralmente por estiramento, contração ou compressão, causando paralisia vocal. Não é surpreendente que o nervo laríngeo recorrente esquerdo, com seu curso mais longo, contornando o arco aórtico, seja mais frequentemente afetado que o direito - que cursa ao redor da artéria subclávia. OBJETIVOS: Discutir a patogênese da rouquidão resultante de lesão cardiovascular que envolve o nervo laríngeo recorrente, juntamente com uma revisão da literatura. MATERIAIS E MÉTODOS: Este trabalho relata uma série de quatro casos de Síndrome de Ortner resultantes de diferentes causas. Tipo de estudo: Estudo de Casos. RESULTADO: A Síndrome de Ortner pode representar uma causa de rouquidão em pacientes com doenças cardiovasculares. CONCLUSÃO: Apesar de rouquidão ser frequentemente encontrada em ambulatórios de otorrinolaringologia, sua etiologia associada ao aparelho cardiovascular é pouco frequente. Laringoscopia indireta dever ser empregada rotineiramente em todos os casos de doenças cardíacas.

Descompressão artroscópica indireta do cisto espinoglenoidal com neuropatia do supraescapular: relato de dois casos e revisão da literatura / Indirect arthroscopic decompression of spinoglenoid cyst with suprascapular neuropathy: report of two cases and literature review

A compressão do nervo supraescapular é entidade rara e deve ser considerada no diagnóstico diferencial de pacientes com dor no ombro e déficit de rotação externa. O cisto espinoglenoidal pode ser a causa da compressão e a lesão do lábio posterossuperior da glenoide a hipótese mais provável que explica o seu aparecimento. A ressonância magnética e a eletroneuromiografia definem o diagnóstico. A descompressão artroscópica indireta do cisto e o reparo do lábio glenoidal permitem completa recuperação neurológica. Os autores relatam dois casos de paralisia isolada do músculo infraespinal causados pela compressão de cistos espinoglenoidais tratados por artroscopia, bem como sua avaliação pré e pós-operatória.

Suprascapular nerve compression is rare and should be considered in the differential diagnosis of patients with shoulder pain and lateral rotation strength deficit. Spinoglenoidal cyst may be the reason for compression and a posterior superior glenoid lip rupture may be the most probable hypothesis for their appearance. Magnetic resonance imaging and electromyography define the diagnosis. Indirect arthroscopic decompression of the cyst and repair of glenoid lip allow for a neurologically complete recovery. The authors report two cases of isolated paralysis of the infraspinatus muscle caused by compression of spinoglenoids cysts treated by arthroscopy, as well as its pre- and post-operative assessment.

Tumor de vaina nerviosa periférica maligno asociado a neurofibromatosis tipo 1: informe de dos casos / Malignant peripheral nerve sheath tumors associated with neurofibromatosis type 1: report of two clinical cases

Introducción: El tumor de vaina nerviosa periférica maligno (TVNPM) es un sarcoma de alto grado de malignidad, originado de componentes de las vainas nerviosas, fibroblastos, células perineurales y células de Schwann, que se asocia a neurofibromatosis tipo 1 con un riesgo de 10 a 13 %. Casos clínicos: Se presentan dos casos de TVNPM asociado a neurofibromatosis tipo 1. El primero presentó dolor moderado sin causa aparente, además de lesión intrarraquídea en resonancia magnética nuclear, manejada quirúrgicamente en dos ocasiones. Histológicamente correspondió a lesión neurofibromatosa en transición con neoplasia maligna. El segundo se manifestó con cifoescoliosis torácica, dolor y aumento de volumen. Asociado a la deformidad, la resonancia magnética mostró tumor en la región torácica posterior (T1 a T8), que fue resecado; se identificó neoplasia sarcomatosa infiltrante, muy celular, con inmunopositividad para proteína S100 y vimentina. Conclusiones: Los TNVPM son sarcomas con alto índice de recurrencia, capaces de producir metástasis a distancia desde etapas tempranas. A pesar de la resección amplia, los pacientes descritos no sobrevivieron dado el avance y tamaño de las lesiones. Por el crecimiento progresivo de los TNVPM y la dificultad anatómica para su abordaje, deberá tenerse un control estrecho de los pacientes con neurofibromatosis tipo 1 a fin de identificar tempranamente la transformación maligna de las lesiones.

BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) is a sarcoma with a high grade of malignancy originating in the nerve sheath components, fibroblasts, perineural cells, and Schwann cells. It is associated with neurofibromatosis type 1 (NF-1) with a risk of 10-13%. CLINICAL CASES: We present two cases of NF-1-associated MPNST. The first patient presented moderate pain with no apparent cause, in addition to the presence of intraspinal lesion demonstrated by nuclear magnetic resonance imaging (NMRI), which was managed surgically on two occasions. Histologically, it corresponded to a neurofibromatosis lesion in transition with malignant neoplasm. The second case manifested with thoracic kyphoscoliosis, pain, and an increase in volume. Associated with the deformity, MRI showed a withering tumor in the posterior thoracic region (T1-T8), observing an infiltrating, cellular sarcomatous neoplasm with immunopositivity for S-100 protein and vimentin. CONCLUSIONS: MPNSTs are sarcomas with a high index of recurrence with the ability to produce distant metastasis during early stages. Despite wide resection, patients did not survive due to the advancement and size of the lesions (determining factors in the prognosis). Due to the progressive growth of MPNST and the anatomic difficulty for its approach, there should be strict surveillance of patients with NF-1 for early detection of malignant transformation in these lesions.

Hemangioma vertebral del arco posterior con extensión extraósea y sintomatología neurológica: informe de un caso y revisión de la literatura / Vertebral hemangioma of the posterior arch with subsequent extraosseous extension and neurological symptoms: case report and literature review

Introducción: El hemangioma vertebral es el tumor más común de la columna vertebral, se identifica hasta en 11 % de las autopsias. Es tipificado como una malformación benigna vascular de crecimiento lento; en ocasiones involucra los elementos posteriores, asociándose a compromiso neurológico. Por lo general es asintomático, encontrándose de forma incidental al estudiar el dolor de origen espinal en busca de otra patología; ocasionalmente produce manifestación neurológica. La extensión extraósea intrarraquídea con compromiso neurológico ha sido poco informada y representa un reto terapéutico. Caso clínico: Adolescente femenina con hemangioma vertebral de tamaño inusual del arco posterior con extensión hacia el conducto raquídeo que ocasionó manifestaciones neurológicas y ameritó tratamiento quirúrgico para su resección y fijación transpedicular. Conclusiones: El hemangioma vertebral es una lesión asintomática que no requiere tratamiento específico. Solo en algunos casos es necesario el tratamiento quirúrgico, que debe llevarse a cabo oportunamente cuando hay compresión neurológica, para evitar secuelas permanentes. El crecimiento extraóseo intrarraquídeo con deterioro neurológico es una presentación inusitada.

BACKGROUND: Vertebral hemangioma is the most common benign spinal tumor and is found in 11% of postmortem studies as a slow-growing benign vascular malformation. It usually involves the vertebral body and sometimes the posterior vertebral elements. When the posterior elements are involved, spinal cord compression with neurological symptoms are seen more often. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to the rare compression lesion. Extraosseous extension of vertebral hemangioma with cord compression and neurological symptoms is a rare condition and represents a treatment challenge. Surgical options are open resection, embolization or vertebroplasty. CLINICAL CASE: We report a case of a vertebral hemangioma with extraosseous extension to the spinal canal with an unusual size and osseous component in the posterior elements. This tumor caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods. Clinical outcome was good. CONCLUSIONS: Vertebral hemangioma is normally an asymptomatic benign lesion not requiring specific treatment. Only in a few cases is surgical treatment required. When neurological compromise is present, early treatment should be carried out before the presence of permanent paralysis.

Synovial cysts and compression neuropathies: a case report

Synovial cysts may arise from any joint affected with an inflammatory arthropathy and can cause compression of adjacent structures. The commonest joint affected is the knee. Synovial cysts arising from other joints are uncommon and those arising from the elbow joint are a rarity. Here we describe a patient with rheumatoid arthritis who presented with right ulnar nerve palsy due to a large synovial cyst arising from the elbow joint and extended into the forearm. In addition to the description of the case a literature review of compression neuropathies secondary to synovial cysts has been performed

Subperiosteal hematoma and orbital compression syndrome following minor frontal trauma in sickle cell anemia: case report / Hematoma subperiósteo e compressão orbitária após trauma frontal leve na anemia falciforme: relato de caso

We report the case of an 11-year-old girl with sickle cell disease who presented to the emergency room after being hit by a mud pie in the left frontal region. Examination evidenced left eye proptosis, eyelid swelling, reduced visual acuity and afferent pupillary defect, without any inflammatory signs such as fever, hyperemia or tenderness. Computed tomography of the orbits showed a large superomedial subperiosteal hematoma in the left orbit. The patient was treated with canthotomy, cantholysis and surgical draining of the hematoma. Two days after drainage she persisted with a subperiosteal hematoma and low visual acuity. A wide exploration of the orbital roof through a lid crease approach disclosed a thickened superior orbital rim with multiple bone defects along the roof and with continuous bleeding. Hemostasis was accomplished with bone wax. Orbital compression was resolved and the patient recovered her previous normal visual acuity.

Relatamos o caso de uma menina de 11 anos com doença falciforme, trazida à sala de emergência após ser atingida por um bloco de barro na região frontal esquerda. Apresentava ao exame proptose do olho esquerdo, edema palpebral, diminuição da acuidade visual e defeito pupilar aferente, sem quaisquer sinais inflamatórios como febre, hiperemia ou aumento de sensibilidade. A tomografia computadorizada de órbitas demonstrou um extenso hematoma subperiósteo superomedial na órbita esquerda. A paciente foi tratada com cantotomia, cantólise e drenagem cirúrgica do hematoma. Dois dias após a drenagem, ela permaneceu com um hematoma subperiósteo e a acuidade visual diminuída. Uma ampla exploração através de incisão no sulco palpebral superior revelou um rebordo orbitário superior espessado, e múltiplos defeitos ósseos ao longo do teto da órbita com sangramento persistente. Foi realizada hemostasia com cera óssea. A compressão orbitária foi resolvida, e a paciente recuperou a acuidade visual normal prévia.

effect of long-term use of computer mouse devices on median nerve entrapment

To assess the effect of long-term use of computer mouse devices on the median nerves. A cross-section prospective study conducted during the year 2004 involved 41 male secretaries employed in the Health Colleges of King Khalid University in Abha, Kingdom of Saudi Arabia. A questionnaire describing sociodemographic and computer use was completed. The electrophysiological study included measurements of motor latencies, motor conduction velocities, and amplitudes of compound muscle action potential of the right median nerve and compared these with those of the left median nerve [control]. All of our subjects were right handed. Terminal latency index [TLI] was calculated for each nerve tested. Entrapment neuropathy of the median nerve at the wrist was defined as TLI <0.30. The mean TLI of the median nerve in the right hand was significantly lower than that in the left hand. Eight of the 23 asymptomatic participants [34.8%], 6 of the 12 who reported hand discomfort [50%], and all the 6 participants who met clinical criteria for carpal tunnel syndrome showed electrophysiological evidence suggestive of right median nerve entrapment neuropathy at the wrist. Test of association showed a negative and significant correlation between TLI of the right median nerve and weekly hours mouse device use while no significant correlation was found between TLI in the same hand and weekly hours keyboard use. Frequent computer mouse device users are at high risk of developing median nerve entrapment neuropathy at the wrist

Fracture of supracondylar process of the humerus

The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature

Oligosymptomatic and giant basilar artery dolichoectasia discovered after a stroke: case report

The most frequently diagnosed complication of vertebrobasilar dolichoectasia (VBD) is the compression of structures adjacent to the vertebral and basilar arteries. A giant VBD with only slight compressive symptoms is unusual. In this setting, the diagnosis of VBD may be casually revealed after the occurrence of a posterior circulation stroke, another potential complication. We report a 48-year-old woman who presented a two-month history of continuous buzz and a slight right-sided hearing loss that was followed by a cerebellar ischemic stroke. Brain CT and MRI revealed a marked compression of the brainstem due to an ectatic, tortuous and partially thrombosed basilar artery (BA). The largest cross-sectional diameter of BA was 18 mm. The patient had a good functional recovery within the two-month follow-up after stroke with modified Rankin scale score (mRSS)=2. At the one-year follow-up, patient still kept the complaints of continuous buzz, slight right-sided hearing loss and the mRSS was the same. We call attention for an unusual giant VBD that caused an impressive brainstem compression with displacement of important structures in an oligosymptomatic patient. Diagnosis was made only after the occurrence of a stroke. Despite of the good functional recovery after stroke, the presence of significant atherosclerotic changes and the large BA diameter may indicate a poor outcome. However, after one year, she remains oligosymptomatic.

A complicação mais freqüentemente encontrada na dolicoectasia vertebrobasilar (DVB) é a compressão de estruturas adjacentes às artérias vertebrais e à artéria basilar. Uma DVB gigante apenas com sintomas compressivos leves é infreqüente. Nesse caso, o diagnóstico pode ser descoberto ao acaso após uma isquemia da circulação posterior, outra complicação possível da DVB. Relatamos o caso de uma mulher de 48 anos com história de zumbido e perda auditiva leve a direita por 2 meses, desenvolvendo, a seguir, uma isquemia cerebelar. A tomografia e a ressonância magnética demonstraram uma compressão acentuada do tronco cerebral devido a uma artéria basilar (AB) ectásica, tortuosa e preenchida parcialmente por trombo. O maior diâmetro axial da AB tinha 18 mm. A paciente apresentou boa recuperação funcional dentro dos primeiros dois meses após a isquemia, com escore de Rankin modificado (ERM)=2. Após um ano, a paciente ainda mantinha as queixas de zumbido e perda auditiva leve à direita, e o ERM ainda se mantinha=2. Chamamos a atenção para um caso raro de DVB gigante que causou impressionante compressão do tronco cerebral, com deslocamento de importantes estruturas, numa paciente oligossintomática. O diagnóstico só foi realizado após a ocorrência da isquemia. Apesar da boa recuperação funcional inicialmente observada, a presença de alterações ateroscleróticas e o grande diâmetro da AB podem indicar um prognóstico ruim. Contudo, após um ano a paciente ainda se mantinha oligossintomática.

Atrapamiento del nervio pudendo: un síndrome por conocer / Pudendal nerve entrapment syndrome

El atrapamiento del nervio pudendo comprende un síndrome descrito por primera vez en 1987. Entre los múltiples motivos de consulta se encuentra principalmente el dolor perineal y/o pelviano, lo que puede asociarse a disfunción urinaria, anal e incluso sexual. Las tres ramas terminales poseen en diferente proporción fibras motoras, sensitivas y autonómicas. Por ello su atrapamiento puede causar signos y síntomas de expresión en cualquiera de los tres ámbitos. En total se estima que el 30 por ciento es autonómico y el 70 por ciento es somático (50 por ciento sensitivo y 20 por ciento motor). El dolor es la causa más común de consulta. Clásicamente se describe como perineal, que se agrava al sentarse, disminuye o desaparece al estar de pie, habitualmente ausente al acostarse, y no compromete el sueño. Para su diagnóstico se utiliza la certificación de 2 criterios mayores o 1 criterio mayor asociado a 2 criterios menores. El mejor esquema de tratamiento es secuencial y comprende las siguientes etapas: etapa 1 o de autocuidado, etapa 2 o de inyecciones perineurales y etapa 3 o cirugía de descompresión del nervio pudendo.

Symmetric Lipofibromatous Hamartoma Affecting Digital Nerves

Lipofibromatous hamartoma of the nerve is a benign tumor, which affects the major nerves and their branches in the human body. It is often found in the median nerve of the hand and is commonly associated with macrodactyly, but it is rarely found in the digital nerves at the peripheral level. This tumor is often found in young adults and may go through a self- limiting course. However, operation is indicated when the tumor size is large or when the associated nerve compressive symptoms are present. We have experienced a rare case of lipofibromatous hamartoma that symmetrically involved the volar digital nerves of both index fingers on the ulnar side. With the aid of a microscope, we dissected and removed the tumor as much as possible without sacrificing the nerve. No sensory change occurred in both fingers and no sign of recurrence was observed upon follow-up.

Meralgia paraesthetica following lumbar spine surgery: a study in 110 consecutive surgically treated cases.

BACKGROUND: Lateral cutaneous femoral nerve (LCFN) injury or Meralgia paraesthetica (MP) results in restriction of activity. Compression of the nerve by disc hernia, retroperitoneal tumors, and external pressure around the anterior superior iliac spine is common. However, it is not commonly observed after lumbar spinal surgery in prone position. STUDY DESIGN: In this prospective study of 110 patients who underwent elective lumbar spinal surgery, managed from January 2002 to June 2002, the incidence, possible risk factors, etiopathogenesis and management of MP were analyzed. RESULTS: There were 66 males and 44 females. The age of the patients ranged from 15 to 81 years (mean 46.9 yrs.). Thirteen patients (12%) suffered from MP. It is more common in thinner individuals due to pressure injury to the nerve at its exit point. Ninety-two per cent of the patients were asymptomatic at follow-up after 6 months. In 7 out of 13 patients, patchy sensory loss on clinical examination was seen at 6 months. CONCLUSION: MP after posterior lumbar spinal surgery is uncommon. Smaller bolsters may avoid some of the vulnerable pressure points, as the surface area available is relatively smaller. The posts of the Hall-Relton frame over the anterior superior iliac crest should be adequately padded. The condition is usually self-limiting. Surgical division or decompression of the LCFN is reserved for persistent or severe MP.

Craniofacial surgery and optic canal decompression in adult fibrous dysplasia.

A 29-year-old female had a 3-year history of bony swelling over the right frontal area. For 3 months she noticed proptosis of her right eye. Investigations revealed fibrous dysplasia involving the right half of the frontal bone and the right greater and lesser wings of the sphenoid bone. Visual evoked potentials (VEP) showed delayed latencies on the involved side. A craniofacial surgery with optic canal decompression was performed. Follow-up after 2 years revealed normalization of VEP.

Complicações neurológicas determinadas pela anestesia subaracnóidea / Spinal anesthesiaðinduced neurological complications

Justificativa e objetivos - Complicações neurológicas da anestesia subaracnóidea, apesar de raras, podem determinar seqüelas importantes. O objetivo deste estudo é apresentar estas complicações com a finalidade de esclarecer os fatores desencadeantes, o que facilita o diagnóstico das lesões. Conteúdo - Säo apresentadas as seguintes complicações: lesäo de nervo desencadeada pela agulha e cateter, cefaléia pós-punçäo, síndrome da artéria espinhal anterior, hematoma espinhal, meningite bacteriana, meningite asséptica, aracnoidite adesiva, síndrome da cauda eqüina e sintomas neurológicos transitórios. Conclusões - O conhecimento dos fatores desencadeantes de complicações neurológicas determinadas pela anestesia subaracnóidea pode prevenir as lesões, diagnosticar e tratar mais precocemente e, desse modo, mudar o prognóstico das mesmas

Evaluación de las compresiones neurovasculares intracraneales: hallazgos en TC y RM / Neurovascular compression of craniel nerves: CT and MRI findings

Objetivo: La compresión de una estructura nerviosa por un vaso aberrante puede ser asintomática o producir importante sintomatología; en éste caso las imágenes suministran una relevante información clínica y prequirúrgica. Material y métodos: Se estudiaron entre enero de 1998 y marzo de 2001, 27 pacientes: 8 con neuralgia del trigémino, 7 con hemiespasmo del facial, 4 con vértigo y tinnitus pulsátil, 2 con hemiespasmo del facial, 4 con vértigo y tinnitus pulsátil, 2 con hemianopsias, 1 con neuralgia de la fosa amigdalina, 1 con voz bitonal, 1 con hemiatrofia lingual derecha con fasciculaciones, 2 con hipertensión esencial y 1 con cefalea. Todos ellos presentaron evaluación neurológica por 2 especialistas y los resultados fueron interpretados por 2 neurorradiólogos. Resultados: Las imágenes por TC y RM con secuencias especiales permitieron evidenciar las compresiones de los segmentos de entrada de las raíces de los pares craneales V, VII, VIII, IX, X, XII, del quiasma óptico y de la cara anterolateral izquierda del bulbo raquídeo en estrecha relación con el centro vasopresor. También se visualizó un vaso anómalo en el Acueducto de Silvio, impidiendo el flujo normal del LCR. Del total de los pacientes estudiados, el 37 por ciento tuvo confirmación quirúrgica. Conclusiones: La TC y especialmente la RM con secuencias para visualización de vasos demostraron ser métodos muy sensibles y específicos en la detección de la lesión de una estructura nerviosa intracraneal, producto de la compresión por un vaso

Spinal cord and cauda equina compression in 'DISH'.

Diffuse idiopathic skeletal hyperostosis (DISH) has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Precise information is lacking in the world literature. Authors report the results of a retrospective analysis of 74 cases of DISH. Eleven patients presented with progressive spinal cord or cauda equina compression. In nine cases ossified posterior longitudinal ligament (OPLL) and in two cases ossified ligamentum flavum (OLF) were primarily responsible. Surgically treated patients (eight) had far better outcome as compared to the patients managed conservatively, as they had refused surgery. 'DISH' is neither a benign condition, nor it always runs a innocuous clinical course. In fact, in about 15% of the cases, serious neurological manifestations occur, which may require a major neurosurgical intervention.