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1.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 5(1): 56-63, jun. 2018. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088672

ABSTRACT

La vasculitis Primaria del Sistema Nervioso Central (VPSNC) se refiere a un grupo de enfermedades que resultan de la inflamación y destrucción de los vasos sanguíneos de la medula espinal, encéfalo y meninges, tanto en el sector venoso como arterial. La presentación es heterogénea y poco sistematizable. El diagnóstico se establece con un cuadro clínico compatible, una angiografía que evidencie vasculitis y/o biopsia del parénquima encefálico o meninges. Las alteraciones en los estudios de imagen son constantes pero inespecíficas para el diagnóstico y se acompañan habitualmente de alteraciones en el líquido cefalorraquídeo (LCR) y electroencefalograma (EEG) Presentamos un paciente con probable VPSNC basados en un cuadro clínico compatible, hallazgos imagenológicos sugestivos, junto con alteraciones en LCR y EEG. Se realizó tratamiento en base a corticoides e inmunosupresores con mala respuesta y evolución.


The primary central nervous system vasculitis (VPSNC) refers to a group of diseases that result from inflammation and destruction of the blood vessels of the spinal cord, brain and meninges, both in the venous and arterial sector. The presentation is heterogeneous and unsystematized. The diagnosis is made based on compatible symptoms, supported by an angiography showing evidence of vasculitis and/or biopsy of the brain parenchyma or meninges. Alterations in imaging studies are consistent but nonspecific for diagnostic and are usually accompanied by alterations in the electroencephalogram (EEG) and cerebrospinal fluid (CSF). We present a clinical case of probable VPSNC based on clinical presentation and findings on imagenological studies suggestive vasculitis, along with alterations in CSF and EEG. Treatment was based on Corticosteroids and immunosuppressive agents with poor response and evolution.


Vasculite Primária do Sistema Nervoso Central (VPSNC) refere-se a um grupo de doenças que resultam de inflamação e destruição dos vasos sanguíneos na medula espinal, o sector venosa arterial cerebral e meninges, ambos. A apresentação é heterogênea e não muito sistematizável. O diagnóstico é estabelecido com um quadro clínico compatível, uma angiografia que evidencia vasculite e / oubiópsia do parênquima cerebral ou meninges. Alterações nos estudos de imagemsão constantes, mas não específica para o diagnóstico e são normalmente acompanhadas por alterações no líquido cefalorraquidiano (LCR) e eletroencefalograma (EEG) descrevem um paciente com VPSNC provável com base em um quadro clínico, achados de imagem sugestivos compatíveis, em conjunto com alterações no CSF e EEG. O tratamento foi realizado com base em corticosteróides e imunos supressores compouca resposta e evolução.


Subject(s)
Humans , Female , Middle Aged , Methylprednisolone/administration & dosage , Prednisolone/administration & dosage , Vasculitis, Central Nervous System/drug therapy , Vasculitis, Central Nervous System/diagnostic imaging , Cyclophosphamide/administration & dosage , Immunosuppressive Agents/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Cerebral Infarction/diagnostic imaging , Treatment Outcome , Constriction, Pathologic/diagnostic imaging , Anterior Cerebral Artery/pathology , Middle Cerebral Artery/pathology , Vasculitis, Central Nervous System/diagnosis
2.
Yonsei Medical Journal ; : 123-130, 2017.
Article in English | WPRIM | ID: wpr-65054

ABSTRACT

PURPOSE: Patients with superficial middle cerebral artery (MCA) territory infarction may have concomitant lenticulostriate artery (LSA) territory infarction. We investigated the mechanisms thereof and the outcomes of patients with superficial MCA territory infarction according to the presence or absence of LSA involvement. MATERIALS AND METHODS: Consecutive patients with first-ever infarction in the unilateral superficial MCA territory were included in this study. They were divided into the superficial MCA only (SM) group and the superficial MCA plus LSA (SM+L) group. RESULTS: Of the 398 patients, 84 patients (21.1%) had LSA involvement (SM+L group). The SM+L group more frequently had significant stenosis of the proximal MCA or carotid artery and high-risk cardioembolic sources. Stroke severity and outcomes were remarkably different between the groups. The SM+L group showed more severe neurologic deficits (National Institute of Health Stroke Scale score 10.8±7.1 vs. 4.0±5.0, p2) at 3 months was more common in the SM+L group (64.3% vs. 15.9%, p<0.001). During a mean follow-up of 26 months, 67 patients died. All-cause (hazard ratio, 2.246) and stroke (hazard ratio, 9.193) mortalities were higher in the SM+L group than the SM group. In multivariate analyses, LSA involvement was an independent predictor of poor functional outcomes and stroke mortality. CONCLUSION: LSA territory involvement is predictive of poor long-term outcomes in patients with superficial MCA territory infarction.


Subject(s)
Carotid Stenosis/mortality , Constriction, Pathologic/pathology , Female , Humans , Infarction, Middle Cerebral Artery/mortality , Male , Middle Cerebral Artery/pathology , Multivariate Analysis , Severity of Illness Index , Stroke/mortality
3.
Arq. bras. neurocir ; 34(2): 148-152, jun. 2015. ilus
Article in Portuguese | LILACS | ID: biblio-1979

ABSTRACT

Angiolipomas são neoplasias benignas compostas por adipócitos maduros e proliferação vascular angiomatosa de rara ocorrência no Sistema Nervoso Central. É relatado o caso de angiolipoma em cisterna silviana adjacente a aneurisma sacular de artéria cerebral média. São discutidas as características imagenológicas do tumor e a possibilidade de uma origem comum com lesões vasculares intracranianas. Este é o primeiro caso relatado de angiolipoma intracraniano associado a aneurisma de artéria cerebral média.


Angiolipomas are benign neoplasms composed of mature fat cells and vascular angiomatous proliferation of rare incidence in Central Nervous System.It's related a case of angiolipoma in Sylvian fissure associated with cerebral saccular aneurysm of medial cerebral artery. Imagenologic characteristics of the tumor and a possible common origin with intracranial vascular lesions are discussed. This is the first reported case of intracranial angiolipoma involving medial cerebral artery aneurysm.


Subject(s)
Humans , Male , Adult , Aneurysm/complications , Angiolipoma/complications , Brain Neoplasms , Middle Cerebral Artery/pathology , Headache/etiology
4.
Int. j. morphol ; 26(4): 1023-1027, Dec. 2008. ilus
Article in English | LILACS | ID: lil-532941

ABSTRACT

The histology of the middle cerebral artery (MCA) in Nigerian Africans has not been previously studied. One hundred MCAs obtained at autopsy from fifty adult Nigerians were studied. The vessels were processed and stained with Ehrlich's haematoxylin and eosin, elastic Van Gieson and Masson's trichrome stains. Early branches were given off before the perforators in two middle cerebral arteries, and there was one accessory MCA, making an incidence of anomalies of 3 percent. No aneurysm was observed in any of the cases. The internal elastic laminas were well developed but the external elastic laminas of the vessels were poorly developed. Close to the bifurcations the tunica media tapered gradually and at the bifurcations, the tunica media was completely deficient being replaced by the tunica adventitia (Forbus raphé). The tunica adventitia was thicker at the bifurcations (0.21mm) compared to other sites of the vessel. The average thickness of the MCA tunica media at its origin was 0.12mm while that of the tunica adventitia was O.lOmm. These results are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The seemingly low frequency of MCA aneurysms in Nigerian Africans is not due to its anomalies or histology.


La histología de la arteria cerebral media (ACM) de los africanos de Nigeria no ha sido previamente estudiada. Fueron examinadas 100 ACM, obtenidas en autopsias de 50 individuos nigerianos adultos. Las arterias fueron procesadas y teñidas con hematoxilina y eosina de Ehrlich, Van Gieson para fibras elásticas y tricrómico de Masson. Ramas proximales se originan antes de la división en dos arterias cerebrales medias, y había una ACM accesoria, constituyendo una incidencia de anomalías del 3 por ciento. No se observó aneurisma en ninguno de los casos. La lámina elástica interna estaba bien desarrollada, pero la lámina elástica externa de los vasos estaba pobremente desarrollada. Cerca de la bifurcación la túnica media es gradualmente cónica, la túnica media es totalmente deficiente siendo sustituida por la túnica adventicia (Forbus raphé). La túnica adventicia es más gruesa en las bifurcaciones (0.21mm) en comparación con otros lugares del buque. El grosor medio de la túnica media de ACM en su origen fue 0.12mm mientras que el de la túnica adventicia de O.lOmm. Estos resultados son similares a los que han sido descritos en la literatura para Caucásicos. Es importante la afirmación que las anomalías anatómicas de la ACM son raras. La aparentemente baja frecuencia de los aneurismas de ACM en nigerianos africanos no es debido a sus anomalías o a la histología.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Intracranial Aneurysm/pathology , Middle Cerebral Artery/abnormalities , Middle Cerebral Artery/pathology , African Continental Ancestry Group , Nigeria , Risk Assessment
5.
Article in English | WPRIM | ID: wpr-65670

ABSTRACT

Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.


Subject(s)
Humans , Male , Meningeal Neoplasms/complications , Meningioma/complications , Middle Aged , Middle Cerebral Artery/pathology , Neoplasm Invasiveness , Skull Neoplasms/complications , Sphenoid Bone , Subarachnoid Hemorrhage/etiology
6.
Neurol India ; 2004 Mar; 52(1): 87-90
Article in English | IMSEAR | ID: sea-120480

ABSTRACT

From 1996-2002 we treated 5 consecutive cases of pial fistula. There were 3 patients with a single hole-single channel pial fistula and two patients had a complex pial fistula. Three patients presented with intracerebral hematoma and had a focal neurological deficit. One patient presented with history of seizures and 1 patient had headache. The results of the treatment were analyzed both clinically and angiographically. The follow-up period ranged from 6 months to 6 years. All fistulas were treated with concentrated glue. The glue cast included the distal part of the feeding artery, A-V connection and the proximal part of the vein. Post-embolisation angiography showed complete occlusion of two single-hole fistulas and one complex pial A-V fistula and near total occlusion of one single-hole and one complex pial A-V fistula. Four patients had excellent clinical outcome. One patient with single-hole fistula had a hemorrhagic venous infarct resulting in transient hemiparesis.


Subject(s)
Adolescent , Adult , Arteriovenous Fistula/etiology , Carotid Arteries/pathology , Cerebral Angiography , Cerebral Hemorrhage, Traumatic/diagnostic imaging , Cerebral Veins/diagnostic imaging , Child , Child, Preschool , Female , Humans , Male , Middle Cerebral Artery/pathology , Tomography, X-Ray Computed
7.
Arq. neuropsiquiatr ; 59(1): 125-127, Mar. 2001. ilus
Article in English | LILACS | ID: lil-284253

ABSTRACT

Menkes disease is a rare X-linked disorder related to a defect in the copper metabolism. According to the current literature, the most frequent neuroimaging findings are cortical atrophy, chronic subdural effusion or hygroma, and vascular abnormalities. White matter lesions may be present before other features of the disease and may evolve into atrophy. We hereby report a case of Menkes disease with typical history and progression, and an early phase imaging study with important white matter abnormalities, which could have lead to diagnostic difficulties


Subject(s)
Humans , Male , Infant , Brain/pathology , Menkes Kinky Hair Syndrome/pathology , Magnetic Resonance Imaging , Middle Cerebral Artery/pathology
8.
Medical Journal of the Islamic Republic of Iran. 2001; 15 (2): 93-101
in English | IMEMR | ID: emr-57658

ABSTRACT

While a wide array of pathological changes occur in cerebral arteries following subarachnoid hemorrhage [SAH], the most consistent is endothelial damage. Since the endothelium normally modulates reflexes that influence vascular tone, any damage to it may represent a significant contributor to cerebral vasospasm following SAH. This experimental study investigates the correlation between endothelial injury of rat basilar [BA] and middle cerebral arteries [MCA] and vasospasm following a double SAH. Animals were divided into three groups of control [nonsurgical-noninjected], saline-injected, and blood-injected rats. Rats in the blood-injected group were injected with two 0.3 mL doses of autologous blood into the subarachnoid space at intervals of 72 hours. Rats were killed at different time intervals to study the time course of endothelial injury along with vasospasm following the second SAH with scanning electron microscopy and image analysis system, respectively. Cerebral arteries exposed to blood demonstrated severe pathological alterations during acute [30 min. to 2 hrs.] and chronic [48 hrs.] periods of time post second SAH. Concurrent with endothelial injury, there was widening of inter-endothelial tight junctions. Morphometric evaluation revealed severe arterial constriction starting at 30 min. [p<0.01] and again at 48 hrs. [p<0.05] post second SAH. The correlation between the time course of ultrastructural alteration of endothelial cells with arterial constriction provides further morphological contribution to the major complication of SAH-cerebral vasospasm


Subject(s)
Animals, Laboratory , Endothelium, Vascular/injuries , Vasospasm, Intracranial , Middle Cerebral Artery/pathology , Basilar Artery/pathology , Microscopy, Electron, Scanning , Rats, Sprague-Dawley
9.
Rev. mex. angiol ; 28(1): 11-6, ene.-mar. 2000. ilus
Article in Spanish | LILACS | ID: lil-286173

ABSTRACT

En 1947 Dandy publica una monografía sobre aneurismas intracraneanos y en ella refleja el pesimismo que le generó el intervenir pacientes con aneurismas de la arteria cerebral media. Hoy en día, éstos continúan teniendo una morbimortalidad alta, a pesar de los adelantos en las técnicas microquirúrgicas, imagenológicas y anestésicas. Esta revisión analiza los aspectos más relevantes relacionados con los diferentes abordajes quirúrgicos, dependiendo de la proyección del saco.


Subject(s)
Intracranial Aneurysm/surgery , Microsurgery , Middle Cerebral Artery/pathology , Aneurysm/surgery , Cerebrum/surgery
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