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2.
Rev. cuba. anestesiol. reanim ; 20(2): e661, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289355

ABSTRACT

Introducción: La cefalea posterior a la punción de la duramadre es una complicación que se describió conjuntamente con la primera anestesia neuroaxial. Es un cuadro clínico complejo, que con la terapéutica adecuada mejora rápidamente, pero en ocasiones persiste a pesar de los esfuerzos realizados por el equipo médico encargado de tratarla. Objetivo: Describir la evolución clínica de un caso cefalea pospunción dural. Discusión: Se presenta un caso que después de realizarle a una anestesia subaracnoidea para una cirugía de Hallux Varus, sufre una cefalea pospunción dural que persistió por más de 18 días, a pesar de los tratamientos impuestos, tanto conservadores (terapia farmacológica, hidratación, reposo) como intervencionista (hemoparche peridural y colchón hídrico, con dextran 40), el cuadro desapareció por si solo pasado el tiempo expuesto anteriormente. Conclusiones: Se concluye que este cuadro clínico ocasionado por la punción de la duramadre es de resolución rápida con el tratamiento adecuado, pero existen casos en los que a pesar de la terapéutica indicada puede persistir por más tiempo(AU)


Introduction: Headache after dura mater puncture is a complication described together with the first neuraxial anesthesia. A complex clinical picture improves rapidly with adequate therapy, but sometimes persists despite the efforts made by the medical team in charge of treating it. Objective: To describe the clinical evolution of case of postdural puncture headache. Discussion: A case is presented of a patient who, following subarachnoid anesthesia for hallux varus surgery, suffered postdural puncture headache that persisted for more than eighteen days, despite the treatments used, both conservative (pharmacological therapy, hydration, rest) and interventionist (peridural hemopatch and water mattress, with dextran 40). The clinical picture disappeared by itself after the time previously discussed. Conclusions: It is concluded that this clinical picture caused by the dura mater puncture is of rapid resolution if treated appropriately, but there are cases in which, despite the indicated therapy, it may persist for a longer time(AU)


Subject(s)
Humans , Female , Middle Aged , Drug Therapy , Dura Mater , Hallux Varus , Post-Dural Puncture Headache , Headache , Clinical Evolution
3.
Arq. neuropsiquiatr ; 78(12): 797-804, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142378

ABSTRACT

ABSTRACT Importance: Hypertrophic pachymeningitis (HP) is a non-usual manifestation of rheumatologic, infectious, and neoplastic diseases. Etiological diagnosis is a challenge, but when made promptly it creates a window of opportunity for treatment, with the possibility of a total reversal of symptoms. Observations: HP is an inflammatory process of the dura mater that can occur as a manifestation of sarcoidosis, granulomatosis with polyangiitis, and IgG4-related disease. The HP case evaluation is extensive and includes central nervous system imaging, cerebrospinal fluid analysis, serology, rheumatologic tests, and systemic survey for other manifestations sites. After systemic investigation, meningeal biopsy might be necessary. Etiology guides HP treatment, and autoimmune disorders are treated with corticosteroids alone or associated with an immunosuppressor. Conclusion: HP is a manifestation of several diseases, and a precise etiological diagnosis is crucial because of the difference among treatments. An extensive investigation of patients with HP helps early diagnosis and correct treatment.


RESUMO Importância: Paquimeningite hipertrófica (PH) é uma manifestação não usual de doenças reumatológicas, infecciosas e neoplásicas. O diagnóstico etiológico por vezes é um desafio, entretanto quando realizado em tempo cria uma janela de tratamento com a possibilidade de reversão total dos sintomas. Observações: A PH é um processo inflamatório da dura-máter que pode ocorrer como manifestação da sarcoidose, granulomatose com poliangeíte e doença relacionada à IgG4. A avaliação dos casos de PH é extensa e inclui imagem do sistema nervoso central, análise de líquor, sorologias, provas reumatológicas e rastreio sistêmico para doença em outros sítios. Por vezes, após toda a investigação sistêmica, a biópsia de meninge é necessária. A etiologia orienta o tratamento da HP, sendo que em doenças autoimunes adota-se o uso de corticosteroides isolados ou associados a um imunossupressor. Conclusão e Relevância: A PH é uma manifestação de várias doenças, e seu diagnóstico etiológico preciso é fundamental, visto a diferença entre os possíveis tratamentos. Uma investigação ampla nos casos de PH ajuda no diagnóstico precoce e tratamento adequado.


Subject(s)
Humans , Meningitis/diagnosis , Meningitis/drug therapy , Magnetic Resonance Imaging , Adrenal Cortex Hormones , Dura Mater/diagnostic imaging , Hypertrophy
4.
Rev. chil. pediatr ; 91(4): 591-596, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138676

ABSTRACT

INTRODUCCIÓN: El síndrome de Marfán es un trastorno multisistémico del tejido conectivo de herencia autosómica dominante, de expresión variable. La ectasia dural es un compromiso frecuente, pero poco conocido, que puede asociarse a síndrome de hipotensión endocraneana (SHE). OBJETIVO: Pre sentar un caso de cefalea invalidante secundario a SHE, para advertir de esta rara complicación, que debe tenerse presente en niños portadores de conectivopatías, en especial síndrome de Marfán. CASO CLÍNICO: Adolescente femenina de 13 años, portadora de sindrome de Marfán, de diagnóstico clínico según criterios de Ghent 2010, que consultó por cefalea ortostatica invalidante de 6 meses de evolución. La Resonancia Magnetica (RM) de cerebro mostró múltiples signos de hipotensión endocraneana, mientras que la RM de columna total mostró una ectasia dural que determinó la dilatación del saco tecal y remodelación posterior de los cuerpos vertebrales, especialmente a nivel del sacro. Se realizó tratamiento con parche sanguíneo autólogo epidural con buena respuesta clínica. CONCLUSIONES: La ectasia dural, frecuente en el sindrome de Marfán, es una causa predisponente a fuga de líquido cefaloraquideo (LCR), que podría causar cefalea ortostática segundaria al SHE.


INTRODUCTION: Marfan syndrome is an autosomal dominant, multi-systemic connective tissue di sorder of different presentations. Dural ectasia is a common, but little known complication that can be associated with intracranial hypotension syndrome (IHS). OBJECTIVE: To present a case of severe headache secondary to IHS in order to warn about this rare complication, which must be considered in children carriers of connective tissue diseases, especially Marfan syndrome. CLINICAL CASE: 13-year- old female carrier of Marfan syndrome, clinically diagnosed according to the 2010 Ghent criteria, who consulted due to a 6-months history of severe orthostatic headache. Head magnetic resonance imaging (MRI) showed multiple signs of intracranial hypotension, while whole-spine MRI showed dural ectasia that caused the thecal sac dilation and subsequent remodeling of vertebral bodies, es pecially the sacral ones. Treatment with an autologous epidural blood patch was administered with good clinical response. CONCLUSIONS: Dural ectasia, frequent in Marfan syndrome, is a predisposing cause of cerebrospinal fluid (CSF) leakage, which could cause orthostatic headache secondary to IHS.


Subject(s)
Humans , Female , Adolescent , Intracranial Hypotension/etiology , Dura Mater/pathology , Headache/etiology , Marfan Syndrome/complications , Magnetic Resonance Imaging , Intracranial Hypotension/pathology , Intracranial Hypotension/diagnostic imaging , Dilatation, Pathologic/etiology , Dilatation, Pathologic/diagnostic imaging , Dura Mater/diagnostic imaging , Headache/pathology , Headache/diagnostic imaging
5.
Int. j. morphol ; 37(4): 1353-1360, Dec. 2019. graf
Article in English | LILACS | ID: biblio-1040137

ABSTRACT

The myodural bridge (MDB) is confirmed that connecting the most of suboccipital muscles to the cervical dura mater through the posterior intervertebral spaces and widely exists in mammals and birds. In order to reveal whether the MDB is universally existing in amniota of vertebrates, we explored the existence and the morphological features of the MDB in the Trachemys scripta elegans. Twenty fresh red-eared slider specimens were observed by the gross anatomy dissection and histological analysis. In the results, three kind of muscles in the postoccipital region of the red-eared slider were found. The rectus capitis dorsum minor muscle originated from the posterior margin of the occiput (C0) and terminated at the spinous process of the atlas (C1). The transversospinales muscle was attached to the vertebral arch and the postzygapophysis of the atlas and extended to the spinous process of the axis (C2). The C2-C3 intertransversales muscle were extended from the postzygapophysis of C2 and the one of C3. The three muscles covered the dorsal interspaces among C0-C3, and meantime they were closely connected with dense connective tissues, which filled in these interspaces. Each of these thick dense connective tissue membranes sent off several short and strong fibrous bundles ventrally to merge with the cervical spinal dura mater. Furthermore the connective tissues connecting these muscles with cervical spinal dura mater directly were revealed under the microscopy and they consisted of parallel and intensive collagen fibers with orientation from dorsal to ventral. In conclusion, this study for the first time demonstrated the existence of the MDB in the testudines, in all of the dorsal atlantooccipital, atlantoaxial and C2-C3 intervertebral spaces. Based on our results and comparative anatomical evidences in recent year, it could be inferred that the MDB might be its highly conserved structure in the evolution of amniota.


Se confirma que el puente miodural (PMD) conecta la mayoría de los músculos suboccipitales con la duramadre cervical a través de los espacios intervertebrales posteriores y existe ampliamente en mamíferos y aves. Para revelar si el MDB existe universalmente en la amniota de vertebrados, exploramos la existencia y las características morfológicas del PMD en Trachemys scripta elegans. Veinte muestras se observaron mediante disección anatómica y análisis histológico. En los resultados, se encontraron tres tipos de músculos en la región occipital. El músculo recto capitis dorsum minor se originó en el margen posterior del occipital (C0) y terminó en el proceso espinoso del atlas (C1). El músculo transverso espinal se unió al arco vertebral y el proceso del atlas y se extendió al proceso espinoso del axis (C2). El músculo intertransversario C2-C3 se extendió entre los procesos transversos de C2 y el de C3. Los tres músculos cubrían los espacios intermedios dorsales entre C0-C3 y, mientras tanto, estaban estrechamente conectados con tejidos conectivos densos, que rellenaban estos espacios. Cada una de estas membranas densas de tejido conectivo envían varios haces fibrosos cortos y fuertes ventralmente para fusionarse con la duramadre espinal cervical. Además, los tejidos conectivos que conectan estos músculos con la duramadre cervical y espinal se revelaron directamente bajo microscopía y consistían en intensas fibras de colágeno, paralelas, con orientación desde dorsal a ventral. En conclusión, este estudio demostró por primera vez la existencia del PMD en los estudios de prueba, en todos los espacios dorsales atlantooccipital, atlantoaxial e intervertebral C2-C3. Sobre la base de nuestros resultados y las evidencias anatómicas comparativas de los últimos años, se podría inferir que el PMD podría ser una estructura altamente conservada en la evolución de la amniota.


Subject(s)
Animals , Turtles/anatomy & histology , Dura Mater/anatomy & histology , Biological Evolution , Head/anatomy & histology , Neck/anatomy & histology
6.
Arq. bras. neurocir ; 38(3): 236-238, 15/09/2019.
Article in English | LILACS | ID: biblio-1362581

ABSTRACT

Introduction Reoperations are a common scenario among glioma patients. There is crescent evidence of its benefit in low- and high-grade gliomas. Here we discuss our experience with inert expanded polytetrafluoroethylene (ePTFE) dura substitute in glioma surgeries. Technical note We generally put the ePTFE dura substitute below the dura of the patient, even if it is intact. This membrane should be sutured in place using a tensionfree technique, with 4-0 polypropylene. Expanded polytetrafluoroethylene minimizes tissue attachment and fibrosis when performing reoperation in glioma patients. Discussion Since the literature has shown benefits in survival with reoperation in glioma patients, the use of ePTFE dura substitute can improve surgical time and minimize complications in a second surgery.


Subject(s)
Polypropylenes/adverse effects , Postoperative Complications , Reoperation/rehabilitation , Glioma/surgery , Dura Mater , Dura Mater/surgery
7.
Coluna/Columna ; 18(3): 176-180, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019777

ABSTRACT

ABSTRACT Objective To evaluate the effects of photodynamic therapy (PDT) on the dura mater using the photosensitizers aluminum chloride phthalocyanine and methylene blue in in vivo assays. Methods Fifty-six male Wistar rats were divided into two groups; one submitted to PDT and the other submitted to the photosensitizers without their photoactivation (control). The photosensitizers were applied to the dura mater after laminectomy at the T10 level. The methods used for assessment were the Basso, Beattie and Bresnahan (BBB) functional evaluation scale and study of the dura mater by light microscopy. Results No changes in motor activity were observed in the animals submitted to PDT compared to control. Histological and pathological evaluation did not show any differences between the group exposed to activated photosensitizers and the control group with regard to the inflammatory process and tissue necrosis. Conclusion The joint use of PDT with the photosensitizing pharmaceuticals aluminum chloride phthalocyanine and methylene blue did not induce any clinical neurotoxic effects or histological changes in the dura mater of the animals studied. Level de evidence V; Expert Opnion.


RESUMO Objetivo Avaliar os efeitos da terapia fotodinâmica (PDT) na dura-máter usando os fotossensibilizadores cloreto de alumínio ftalocianina e azul de metileno em ensaios in vivo. Métodos Cinquenta e seis ratos Wistar machos divididos em dois grupos; um submetido à PDT e o outro submetido aos fotossensibilizadores sem a fotoativação (controle). Os fotossensibilizadores foram aplicados sobre a dura-máter depois de laminectomia no nível T10. Os métodos de avaliação usados foram a escala de avaliação funcional de Basso, Beattie e Bresnahan (BBB) e o estudo da dura-máter por microscopia óptica. Resultados Não foram observadas alterações da atividade motora dos animais submetidos à PDT com relação ao grupo controle. A avaliação histológica e histopatológica não mostrou diferenças entre o grupo exposto aos fotossensibilizadores ativados e o grupo controle, com relação ao processo inflamatório e à necrose tecidual. Conclusões O uso conjunto de PDT e os fármacos fotossensibilizantes cloreto de alumínio ftalocianina e azul de metileno não induziu efeitos neurotóxicos clínicos e/ou alterações histológicas sobre a dura-máter dos animais estudados. Nível de evidência V; Opinião de Especialista.


RESUMEN Objetivo Evaluar los efectos de la terapia fotodinámica (PDT) en la duramadre utilizando los fotosensibilizadores de ftalocianina de aluminio clorada y azul de metileno en ensayos in vivo. Métodos Cincuenta y seis ratas Wistar machos se dividieron en 2 grupos; uno fue sometido a PDT y el otro sometido a fotosensibilizadores sin fotoactivación (control). Los fotosensibilizadores se aplicaron a la duramadre después de la laminectomía en el nivel T10. Los métodos de evaluación utilizados fueron la escala de evaluación funcional de Basso, Beattie y Bresnahan (BBB) y el estudio de la duramadre mediante microscopía óptica. Resultados No hubo cambios en la actividad motora de los animales sometidos a PDT en relación con el grupo de control. La evaluación histológica e histopatológica no mostró diferencias entre el grupo expuesto a fotosensibilizadores activados y el grupo de control con respecto al proceso inflamatorio y la necrosis tisular. Conclusiones El uso conjunto de PDT con las sustancias fotosensibilizadores ftalocianina de aluminio clorada y azul de metileno no indujo efectos neurotóxicos clínicos o cambios histológicos en la duramadre de los animales estudiados. Nivel de evidencia V; Opinión del Especialista.


Subject(s)
Humans , Dura Mater , Phytochemicals , Lasers , Methylene Blue
8.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 94-97, sept. 2019. ilus.
Article in Spanish | LILACS | ID: biblio-1048277

ABSTRACT

Las fístulas arteriovenosas durales medulares son malformaciones vasculares adquiridas que constituyen una causa muy infrecuente de mielopatía progresiva (5-10 casos por millón de habitantes por año). La resonancia magnética es el estudio por imágenes de elección para su diagnóstico. A continuación presentamos el caso de una paciente femenina de 89 años, que consultó a la guardia de nuestra institución por un cuadro de paraparesia moderada asociada a parestesias e incontinencia urinaria posterior a esfuerzo físico. Se le diagnosticó una fístula arteriovenosa dural medular como causante de su cuadro. (AU)


Spinal dural arteriovenous fistulas (SDAVF) are acquired spinal vascular malformations and a rare cause of progressive myelopathy (5-10 new cases per year and per 1 million inhabitants). Magnetic resonance imaging is the diagnosis modality of choice. We present a case of a 89-year-old female patient who consulted the emergency department of our institution because of paraparesis and lower extremities paresthesias associated with urinary incontinence post physical effort. With the final diagnosis of spinal dural arteriovenous fistula, as a cause of the clinical symptoms. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Arteriovenous Fistula/diagnostic imaging , Dura Mater/abnormalities , Paresthesia , Atrial Fibrillation/complications , Spinal Cord Diseases/diagnostic imaging , Tobacco Use Disorder/complications , Urinary Incontinence , Arteriovenous Fistula/etiology , Arteriovenous Fistula/epidemiology , Low Back Pain/complications , Aortic Aneurysm, Abdominal/complications , Paraparesis , Fecal Incontinence , Hypertension/complications , Hypesthesia , Erectile Dysfunction , Anticoagulants/therapeutic use
9.
Int. j. morphol ; 37(2): 719-723, June 2019. tab, graf
Article in English | LILACS | ID: biblio-1002283

ABSTRACT

Mobile phone use has increased rapidly. The central nervous system has been shown to be adversely affected by its electromagnetic field (EMF) resulting in headache and sleep disturbances. How the cells make up the CNS and are affected by EMF is unclear. However, because of their central role in inflammation through diverse stimuli including radiation, this study aimed to investigate the effects of electromagnetic fields induced by mobile phones on mast cells in rat dura mater. A total of 18 adult, female, SpragueDawley rats were divided into two groups. The choice of female rats for his study was based on recent surveys demonstrating that mobile phone use is more frequent and prolonged among females. The study group was exposed to 900 MHz electromagnetic field (1 h/day for 45 days). In the end of the study, duramater tissue was extracted and stained using Toluidine blue. Mast cells were counted and results were analysed using Student t test. Mean mast cell number was 202.33±9.82 and 456.78±35.01 in the control and study groups, respectively (p<0.05). Analysis of serum electrolyte and immunoglobulin E levels showed no statistically significant difference between the two groups (p>0.05). The study showed that mobile phone exposure increased mast cell number and degranulation in rat dura mater. Further studies are required to evaluate the clinical implications of these findings.


El uso del teléfono móvil ha aumentado rápidamente. Se ha demostrado que el sistema nervioso central (SNC) se ve afectado de manera adversa debido al campo electromagnético (CEM) que produce dolor de cabeza y trastornos del sueño. No está claro cómo se ve afectada la composición celular del SNC por el CEM. Sin embargo, debido a su función principal en la inflamación a través de diversos estímulos que incluyen la radiación, este estudio tuvo como objetivo investigar los efectos de los campos electromagnéticos inducidos por los teléfonos móviles en los mastocitos de la duramadre de ratas. Un total de 18 ratas Sprague-Dawley adultas, hembras, se dividieron en dos grupos. Se usaron ratas hembras para este estudio en base a investigaciones recientes que han demostrado que el uso de teléfonos móviles es más frecuente y prolongado en las mujeres. Los grupos de estudio fueron expuestos a un campo electromagnético de 900 MHz (1 h / día durante 45 días). Al término del estudio, fue extirpado el tejido de la duramadre y teñido con azul de toluidina. Se contaron los mastocitos y se analizaron los resultados utilizando la prueba t de Student. La cantidad media de células cebadas fue de 202,33 ± 9.82 y 456,78 ± 35,01 en los grupos control y estudio, respectivamente (p <0,05). El análisis del electrolito sérico y los niveles de inmunoglobulina E no mostraron diferencias estadísticamente significativas entre los dos grupos (p> 0,05). El estudio mostró que la exposición a teléfonos móviles aumentó el número de mastocitos y la desgranulación en la duramadre de las ratas. Se requieren estudios adicionales para evaluar las implicaciones clínicas de estos hallazgos.


Subject(s)
Animals , Rats , Cell Phone , Dura Mater/radiation effects , Electromagnetic Fields/adverse effects , Mast Cells/radiation effects , Rats, Sprague-Dawley
10.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 216-223, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1020336

ABSTRACT

Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares. Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro. Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017. Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamente significativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente). Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. Nivel de Evidencia: IV


Introduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments. Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center. Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017. Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables-percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures-were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively). Conclusions: This study suggests that traumatic thecal sac injury could be suspected when managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracture type C according to the AOSpine Classification System). Level of Evidence: IV


Subject(s)
Adult , Spinal Injuries , Thoracic Vertebrae/injuries , Spinal Fractures/classification , Dura Mater/injuries , Lumbar Vertebrae/injuries
11.
Salud(i)ciencia (Impresa) ; 23(4): 343-347, mar. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1010211

ABSTRACT

La paquimeningitis hipertrófica es una entidad infrecuente que puede ser idiopática o secundaria, y dado que incluso un diagnóstico acertado y un correcto tratamiento pueden dejar secuelas neurológicas graves o, incluso, producir la muerte, presentamos este caso en el que consideramos que la causa fue una meningitis que no recibió tratamiento adecuado al inicio de los síntomas y que tuvo una respuesta satisfactoria al tratamiento con corticoides, inicialmente en altas dosis.


Subject(s)
Humans , Adrenal Cortex Hormones/therapeutic use , Diagnosis , Dura Mater , Meningitis , Meningitis/drug therapy
12.
Rev. cuba. reumatol ; 21(supl.1): e80, 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1099125

ABSTRACT

La paquimeningitis es un raro desorden caracterizado por engrosamiento focal o difuso de la duramadre, siendo una potencial manifestación de la enfermedad relacionada con IgG4. Presentamos 11 pacientes, seis hombres y cinco mujeres, entre 39-73 años, que consultaron por cefalea, alteraciones visuales, acúfenos, hipoacusia, pérdida de peso, agrandamiento de glándulas salivales, dorsalgia, cuadriplejía y compromiso de nervios craneales. Algunos de ellos presentaron elevación de la proteína C reactiva o del valor de sedimentación globular, mientras que la mayoría presentó niveles séricos normales de IgG4. Todos los pacientes mostraron engrosamiento de la duramadre en la resonancia magnética. La biopsia de duramadre, de vesícula biliar, hipófisis o glándula lagrimal, mostró un infiltrado linfoplasmocitario con o sin fibrosis estoriforme, con más de 10 plasmocitos IgG4 (+) y un rango IgG4: IgG que osciló del 20 al 60 por ciento. Los pacientes recibieron prednisona sola o con rituximab, metotrexate, ciclofosfamida o azatioprina, con respuesta favorable(AU)


Pachymeningitis is a rare disorder characterized by focal or diffuse thickening of the dura mater, being a potential manifestation of the disease related to IgG4. We present 11 patients, six men and five women, aged 39-73 years, who consulted for headache, visual disturbances, tinnitus, hearing loss, weight loss, salivary gland enlargement, dorsalgia, quadriplegia and cranial nerve involvement. Some of them presented elevation of the C-reactive protein or the erythrocyte sedimentation value, while the majority had normal serum levels of IgG4. All patients showed thickening of the dura in magnetic resonance imaging. The biopsy of dura mater, gallbladder, pituitary gland or lacrimal gland showed a lymphoplasmacytic infiltrate with or without storiform fibrosis, with more than 10 IgG4 (+) plasmocytes and an IgG4: IgG range that ranged from 20 to 60 percent. Patients received prednisone alone or with rituximab, methotrexate, cyclophosphamide or azathioprine, with favorable response(AU)


Subject(s)
Humans , Cranial Nerves , Dura Mater , Meningitis , Magnetic Resonance Imaging
13.
Neurointervention ; : 9-16, 2019.
Article in English | WPRIM | ID: wpr-741678

ABSTRACT

Intracranial and spinal dural arteriovenous fistulas (DAVFs) are vascular pathologies of the dural membrane with arteriovenous shunts. They are abnormal communications between arteries and veins or dural venous sinuses that sit between the two sheets of the dura mater. The dura propria faces the surface of brain, and the osteal dura faces the bone. The location of the shunt points is not distributed homogeneously on the surface of the dural membrane, but there are certain areas susceptible to DAVFs. The dura mater of the olfactory groove, falx cerebri, inferior sagittal sinus, tentorium cerebelli, and falx cerebelli, and the dura mater at the level of the spinal cord are composed only of dura propria, and these areas are derived from neural crest cells. The dura mater of the cavernous sinus, transverse sinus, sigmoid sinus, and anterior condylar confluence surrounding the hypoglossal canal are composed of both dura propria and osteal dura; this group is derived from mesoderm. Although the cause of this heterogeneity has not yet been determined, there are some specific characteristics and tendencies in terms of the embryological features. The possible reasons for the segmental susceptibility to DAVFs are summarized based on the embryology of the dura mater.


Subject(s)
Arteries , Brain , Cavernous Sinus , Central Nervous System Vascular Malformations , Colon, Sigmoid , Dura Mater , Embryology , Membranes , Mesoderm , Neural Crest , Pathology , Population Characteristics , Spinal Cord , Veins
14.
Article in English | WPRIM | ID: wpr-765397

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the biomechanical differences between human dura mater and dura mater substitutes to optimize biomimetic materials. METHODS: Four groups were investigated. Group I used cranial dura mater (n=10), group II used Gore-Tex® Expanded Cardiovascular Patch (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) (n=6), group III used Durepair® (Medtronic Inc., Goleta, CA, USA) (n=6), and group IV used Tutopatch® (Tutogen Medical GmbH, Neunkirchen am Brand, Germany) (n=6). We used an axial compression machine to measure maximum tensile strength. RESULTS: The mean tensile strengths were 7.01±0.77 MPa for group I, 22.03±0.60 MPa for group II, 19.59±0.65 MPa for group III, and 3.51±0.63 MPa for group IV. The materials in groups II and III were stronger than those in group I. However, the materials in group IV were weaker than those in group I. CONCLUSION: An important dura mater graft property is biomechanical similarity to cranial human dura mater. This biomechanical study contributed to the future development of artificial dura mater substitutes with biomechanical properties similar to those of human dura mater.


Subject(s)
Biomimetic Materials , Collagen , Dura Mater , Humans , In Vitro Techniques , Mechanics , Pericardium , Polytetrafluoroethylene , Tensile Strength , Transplants
15.
Article in English | WPRIM | ID: wpr-765369

ABSTRACT

OBJECTIVE: The primary aim of this investigation was to explore the nature of dura mater biomechanics following the introduction of puncture defect(s). METHODS: Twenty-eight dura mater specimens were collected during autopsy from the department of forensic medicine of the authors' institution. Specimens were divided randomly into one of four groups : group I (cranial dura mater; n=7), group II (cranial dura mater with one puncture defect; n=7); group III (cranial dura mater with two puncture defects; n=7), and group IV (cranial dura mater with three puncture defects; n=7). RESULTS: The mean±standard deviation tensile strengths of the dura mater were 8.35±3.16, 8.22±3.32, 7.13±1.77, and 6.94±1.93 MPa for groups I, II, III, and IV, respectively. There was no statistical difference between all groups. A single, two or more punctures of the dura mater using a 20-gauge Quincke needle did not affect cranial dura tensile strength. CONCLUSION: This biomechanical study may contribute to the future development of artificial dura mater substitutes and medical needles that have a lower negative impact on the biomechanical properties of dura mater.


Subject(s)
Autopsy , Biomechanical Phenomena , Dura Mater , Forensic Medicine , In Vitro Techniques , Needles , Punctures , Tensile Strength
16.
Asian Spine Journal ; : 361-367, 2019.
Article in English | WPRIM | ID: wpr-762957

ABSTRACT

STUDY DESIGN: Experimental study. PURPOSE: To determine whether epidural fat (EF) tissue contains mesenchymal stem cells (MSC). OVERVIEW OF LITERATURE: Spine surgeons are unaware of the contents of EF tissue and the reason for its presence between the ligamentum flavum and the dura mater; therefore, EF tissues are routinely eliminated during surgical procedures. However, EF removal causes certain postoperative problems, such as post-laminectomy syndrome. We hypothesized that the EF tissue may play a significant supportive role for the neural structures and other nearby conditions. METHODS: EF tissues were obtained from consenting patients (n=3) during posterior decompression surgery of the lumbar spine. The primary cells were isolated and cultured as per previously described methods with some modifications, and the cell morphology and cumulation were examined. Thereafter, reverse transcription–polymerase chain reaction (RT-PCR), a fluorescence-activated cell sorting (FACS) analysis, and differentiation potency for differentiation into osteoblasts, chondroblasts, and adipocytes were investigated to identify whether the cells derived from EF are MSC. RESULTS: The cells from the EF tissue had a fibroblast or neuron-like morphology that persisted until the senescence at p18. MSC-specific genes, such as OCT4, SOX2, KLF4, MYC, and GAPDH were expressed in the RT-PCR study, while MSC-specific surface markers such as CD105, CD90, and CD73 were exhibited in the FACS analysis. The differentiation properties of EF-MSC for differentiation into the three types of cells (osteoblast, chondroblast, and adipocyte) were also confirmed. CONCLUSIONS: Based on the cell culture, FACS analysis, RT-PCR analysis, and differentiation potent outcomes, all the features of the cells corresponded to MSC. This is the first study to identify EF-MSC derived from the EF tissue.


Subject(s)
Adipocytes , Aging , Cell Culture Techniques , Chondrocytes , Decompression , Dura Mater , Fibroblasts , Flow Cytometry , Humans , Ligamentum Flavum , Mesenchymal Stem Cells , Osteoblasts , Spine , Surgeons
17.
Article in English | WPRIM | ID: wpr-762746

ABSTRACT

Here we report a case of a focal atypical proliferative nodule (PN) arising from a congenital melanocytic nevus (CMN). Diagnosis was challenging because it had both benign and malignant clinical features. Unusual histopathology, immunohistochemistry, and intraoperative findings of this atypical PN are discussed. A 5-year-old girl was admitted for a congenital 5× 5 cm sized scalp mass. This hemangioma-like soft mass showed biphasic characteristics such as a slow, gradual, and benign increase in size but worrisome dural invasion with cranial bone defect. We removed the scalp mass with clear resection margins. Interoperatively, we found that the cranial bone defect had already filled. Histopathologic examination showed CMN with focal atypical PN. The nodule showed sharp demarcation and cellular pleomorphism. However, in immunohistochemical study, Ki-67 proliferation index and expression levels of protein S-100 and Melan-A were very low. These were unusual findings of atypical PNs. Despite her worrisome preoperative radiologic features, she showed an indolent clinical course compatible with previously reported biologic behavior. The patient underwent follow-up inspection with magnetic resonance imaging every 6 months for up to 3 years. The nodule appeared to be stationary at the last visit.


Subject(s)
Child, Preschool , Diagnosis , Dura Mater , Female , Follow-Up Studies , Humans , Immunohistochemistry , Magnetic Resonance Imaging , MART-1 Antigen , Neoplasm Invasiveness , Nevus, Pigmented , Scalp , Tissue Expansion Devices
18.
Anatomy & Cell Biology ; : 337-339, 2019.
Article in English | WPRIM | ID: wpr-762228

ABSTRACT

Variations of the dural folds and the dural venous sinuses are infrequently reported in the existing medical literature. Such variations in the posterior cranial fossa may pose difficulties in various analytical and surgical procedures of this region. We present a rare concurrent variation of the falx cerebelli and tentorium cerebelli that was detected during routine dissection of an adult male cadaver. While removing the brain, a partial duplication of tentorium cerebelli was observed below the left half of the tentorium cerebelli and above the left cerebellar hemisphere. This fold did not have any dural venous sinus in it. Further, a complete duplication of falx cerebelli with a single occipital venous sinus within its attached border was also observed. We present the review of literature and discuss the comparative anatomy of this case.


Subject(s)
Adult , Anatomy, Comparative , Brain , Cadaver , Cranial Fossa, Posterior , Dura Mater , Humans , Male , Meninges , Spinal Cord
19.
Anatomy & Cell Biology ; : 211-213, 2019.
Article in English | WPRIM | ID: wpr-762210

ABSTRACT

Ossification of parts of the intracranial dura mater is common and is generally accepted as an age-related finding. Additionally, duplication of the abducens nerve along its course to the lateral rectus muscle is a known, although uncommon anatomical variant. During routine cadaveric dissection, an ossified portion of dura mater traveling over the trigeminal nerve's entrance (porus trigeminus) into the middle cranial fossa was observed unilaterally. Ipsilaterally, a duplicated abducens nerve was also observed, with a unique foramen superolateral to the entrance of Dorello's canal. To our knowledge, there has been no existing report of a simultaneous ossified roof of the porus trigeminus with an ipsilateral duplicated abducens nerve. Herein, we discuss this case and the potential clinical and surgical applications. We believe this case report will be informative for the skull base surgeon in the diagnosis of neuralgic pain in the frontomaxillary, andibular, orbital, and external and middle ear regions.


Subject(s)
Abducens Nerve , Cadaver , Cranial Fossa, Middle , Diagnosis , Dura Mater , Ear, Middle , Orbit , Skull Base , Trigeminal Neuralgia
20.
Article in English | WPRIM | ID: wpr-788823

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the biomechanical differences between human dura mater and dura mater substitutes to optimize biomimetic materials.METHODS: Four groups were investigated. Group I used cranial dura mater (n=10), group II used Gore-Tex® Expanded Cardiovascular Patch (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) (n=6), group III used Durepair® (Medtronic Inc., Goleta, CA, USA) (n=6), and group IV used Tutopatch® (Tutogen Medical GmbH, Neunkirchen am Brand, Germany) (n=6). We used an axial compression machine to measure maximum tensile strength.RESULTS: The mean tensile strengths were 7.01±0.77 MPa for group I, 22.03±0.60 MPa for group II, 19.59±0.65 MPa for group III, and 3.51±0.63 MPa for group IV. The materials in groups II and III were stronger than those in group I. However, the materials in group IV were weaker than those in group I.CONCLUSION: An important dura mater graft property is biomechanical similarity to cranial human dura mater. This biomechanical study contributed to the future development of artificial dura mater substitutes with biomechanical properties similar to those of human dura mater.


Subject(s)
Biomimetic Materials , Collagen , Dura Mater , Humans , In Vitro Techniques , Mechanics , Pericardium , Polytetrafluoroethylene , Tensile Strength , Transplants
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