Vertebrobasilar insufficiency caused by cervical aneurysmal bone cyst - case report / Insuficiência vertebrobasilar causada por cisto ósseo aneurismático cervical - relato de caso

Aneurysmal bone cysts (ABC) are benign bone tumors of relatively rare occurrence. Most of the lesions occur at long bones, vertebrae and flat bones. However, the cervical vertebrae involvement is uncommon. Occasionally, the ABCs compress the spinal cord and nerve roots. Depending on the level of involvement and the extent of spinal cord compression, a wide variety of neurological symptoms and signs may be noted later, ranging from mild radiculopathy to complete paraplegia or tetraplegia. A case of aneurysmal bone cyst involving the second and third cervical vertebrae in a 15 years old patient, causing compression of the right vertebral artery and subsequent vertebrobasilar insufficiency is reported. We also discuss the clinical manifestations of the vertebrobasilar insufficiency, of the spinal compression, and the surgery treatment performed in this case.

Cistos ósseos aneurismáticos são tumores ósseos benignos de ocorrência relativamente rara. A maior parte dessas lesões ocorre em ossos longos, nas vértebras e nos ossos planos. No entanto, o envolvimento das vértebras cervicais é incomum. Ocasionalmente, o cisto ósseo aneurismático pode comprimir a medula espinhal e as raízes nervosas. Dependendo do grau de envolvimento e extensão da compressão da medula espinhal, uma ampla variedade de sintomas e sinais neurológicos pode ser observada posteriormente, variando de radiculopatia suave a completa paraplegia ou tetraplegia. Relatamos um caso de cisto ósseo aneurismático envolvendo a segunda e a terceira vértebra cervical em um paciente de 15 anos, causando compressão da artéria vertebral direita e consequente insuficiência vertebrobasilar. Também discutimos as manifestações clínicas da insuficiência vertebrobasilar e da compressão espinhal e o tratamento cirúrgico realizado no caso em questão.

Neurosífilis meningovascular con trombosis de la arteria basilar / Meningovascular neurosyphilis with basilar artery thrombosis, a case report and literature review

Se presenta el caso clínico de un paciente de 54 años, negativo para VIH, con enfermedad cerebrovascular por trombosis de la arteria basilar, secundaria a neurosífilis meningovascular. La neurosífilis es el compromiso del sistema nervioso central por Treponema pallidum subespecie pallidum en cualquier estadio de la entidad e incluye las formas asintomáticas y sintomáticas de la infección; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. La recomendación actual es el tratamiento con 4 millones de unidades de penicilina cristalina cada 4 horas por 14 días.

Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.

Endocardite infecciosa com apresentação inicial de abdome agudo / Infective endocarditis with initial presentation of acute abdomen

Paciente de 35 anos de idade foi atendido em Serviço de Emergência com seis horas de dor em fossa ilíaca direita e febre. Feita hipótese diagnóstica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital três dias após alta hospitalar. prostrado. febril. com alteração de fala. diminuição de nível de consciência e com hemiparesia completa à esquerda. CT scan de crânio e punção de líquor normal. RMN de encéfalo revelou aspectos compatíveis com AVC isquêmico vertebro-basilar. Ecocardiograma transesofágico demonstrou vegetação em valva aórtica e insuficiência aórtica moderada e hemoculturas foram positivas para Enterococcus bovis.

A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were normal. Cerebral magnetic resonance image showed aspects compatible with vertebrobasilar ischemic stroke. Transesphofagic echocardiogram showed vegetation of the aortic valve and moderate aortic insufficiency. Blood cultures were positive for Enterococcus bovis.

Peduncular hallucinosis in ‘top of the basilar syndrome’: An unusual complication following coronary angiography.

Cerebral thromboembolism is a potential, although rare, complication of coronary angiography. An elderly woman presented with visual hallucinations, features of bilateral third nerve palsy, impaired vertical and horizontal gaze and mild motor weakness of the left upper limb, following diagnostic coronary catheterization. These findings suggested the anatomical location of the lesion to lie in the caudal midbrain, which was confirmed on computed tomography of the brain. Peduncular hallucinosis following cardiac catheterization, to the best of our knowledge, has only been described once in the literature. Awareness of this entity and its clinical presentation is essential for appropriate investigation and management.

Wallenberg syndrome as a sole presentation of celiac disease

Celiac sprue is a gluten sensitive enteropathy in which there is a small bowel villous atrophy associated with gastrointestinal and extraintestinal symptoms. True prevalence is difficult to ascertain because many patients have atypical symptoms or none at all. Few children display CNS symptoms such as peripheral neuropathy and cerebellar ataxia. So far, stroke in posterior circulation territory as a presentation for celiac disease has not been reported. We report a 15-year-old male patient who presented as Wallenberg syndrome without any positive medical history. Brain MRI confirmed infarction, and magnetic resonance angiography showed vertebral artery stenosis. Laboratory findings revealed anemia and positive serologic tests for celiac disease, and duodenal biopsy confirmed the disease. In any children with symptoms of vertebrobasilar insufficiency, celiac disease as a treatable cause must be considered

Ischemic stroke in the vertebrobasilar system. Risk factors, etiology, and localization

To investigate and determine the clinical findings, lesions, risk factors, and variety of etiology in Turkish patients suffering from vertebrobasilar ischemia. The clinical, radiological, and prognostic features of patients with ischemic stroke in the vertebrobasilar system [VBS] are not homogeneous. The mechanism, localization, and severity of the vascular lesions and the presence of coexisting vascular risk factors influence the prognosis. The study included 134 patients with ischemic strokes in the VBS that were evaluated according to age, gender, clinical findings, risk factors, lesion localization, echocardiography, Doppler sonography, and cervical magnetic resonance angiography at Haydarpa

Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis.

OBJECTIVE: We present our experience of treating nine consecutive cases of rheumatoid arthritis involving the craniovertebral junction by atlantoaxial joint manipulation and attempts towards restoration of craniovertebral region alignments. MATERIAL AND RESULTS: Between November 2001 and March 2004, nine cases of rheumatoid arthritis involving the craniovertebral junction were treated in our department of neurosurgery. Six patients had basilar invagination and 'fixed' atlantoaxial dislocation and three patients had a retroodontoid process pannus and mobile and incompletely reducible atlantoaxial dislocation. The patients ranged from 24 to 74 years in age. Six patients were males and three were females. Neck pain and spastic quadriparesis were the most prominent symptoms. Surgery involved attempts to reduce the atlantoaxial dislocation and basilar invagination by manual distraction of the facets of the atlas and axis. Reduction of the atlantoaxial dislocation and of basilar invagination and stabilization of the region was achieved by placement of bone graft and metal spacers within the joint and direct inter-articular plate and screw method of atlantoaxial fixation. Following surgery all the patients showed symptomatic improvement and restoration of craniovertebral alignments. Follow-up ranged from four to 48 months (average 28 months). CONCLUSION: Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of rheumatoid arthritis involving the craniovertebral junction leads to remarkable and sustained clinical recovery.

Vertebrobasilar strokes in children

This study describes the rare disorder of vertebrobasilar strokes in children and provides an assessment strategy to alert the clinician towards the possibility of this disorder. Method: A retrospective study of vertebrobasilar strokes over 20 years was conducted in the Neurology Department at the New Children's Hospital, Sydney, Australia. There were 6 males and 3 females between the ages of 18 months and 15 years. Frequently presenting features included headache, hemiparesis, ataxia and cranial nerve palsies. Aphasia occurred in 2 and afebrile seizures in 1 patient. Five patients had depressed consciousness extending to coma in 3. Etiological factors included trauma to the head or neck in 5, rheumatic endocarditis with artificial valve embolism in 1, brain stem encephalitis in 1 and undetermined etiology in 2. Diagnostic neuroimaging studies including MRI showed infarction in the territories of the occluded arteries. MRA showed occlusion of the vertebral artery and/or its branches in 5 patients, while the other 4 patients had involvement of the basilar artery and/or its branches. No abnormalities of blood coagulation were detected. Five patients were treated with anticoagulants. Acute hydrocephalus secondary to cerebellar infarction developed in 3 patients. Recurrent vertebrobasilar strokes were reported in 2 males, each of whom was treated surgically. There was 1 late death. Residual neurological deficits were seen in 5 patients and 3 made a complete recovery. Although this disorder is rare in pediatric patients, it is important to consider it in those children with appropriate neurological symptoms and signs

Changes of blood flow velocity indicating mechanical compression of the vertebral arteries during rotation of the head in the normal human measured with transcranial doppler sonography

Estudos anatômicos, angiografias em voluntários normais e relatos clínicos de pacientes com sintomas atestam o fato de que o fluxo sanguíneo através das artérias vertebrais (VA's) é parcialmente obstruido ao nível da articulaçäo atlanto-axial (C1-C2) durante a rotaçäo da cabeça. Variaçöes anatômicas as artérias cerebrais basais, trauma e outros processos patológicos têm sido relacionados à compressäo mecânica fisiológica das VA's na patogenia de insuficiência vertebrobasilar. No presente estudo, as alteraçöes dinâmicas da velocidade do fluxo sanguíneo (BFV) nas artérias do sistema vertebrobasilar, provocadas por rotaçäo da cabeça em voluntários adultos normais, säo medidas com Doppler trnscraniano (TCD) das VA's (segmento intracraniano V4) e artéria basilar (BA). Em 8 indivíduos o estudo foi repetido com um instrumento de TCD de dois canais, permitindo o estudo simultâneo das VA's (grupo 2). A artéria basilar foi examinada com a técnica transforaminal e as VA's com o método transoccipital. Resultados: A BFV na BA e VA's diminuiu de modo significante durante rotaçäo da cabeça no grupo I, idenpendentemente do lado da rotaçäo (p ó 0.001). A mais acentuada diminuiçäo do BFV ocorreu na VA do lado direito durante rotaçäo episilateral (-18 por cento)...

Vertebro-basilar insufficiency due to carotid stenosis.

Two patients with internal carotid disease and normal/hypoplastic vertebro-basilar system presenting with symptoms of vertebrobasilar insufficiency are presented. The role of associated anomalies of the circle of Willis or major vessels in the pathogenesis of symptoms is highlighted.

Estudio de la insuficiencia vertebrobasilar mediante la compresión manual de las arterias vertebrales / Study of the vertebro basilar insufficiency by means of manual compression of the vertebral arteries

Los autores describen un método para estudiar la insuficiencia vértebrobasilar. Consiste en la compresión simultánea bilateral de las arterias vertebrales contra el plano óseo que forman las opófisis transversas, por debajo de la séptima vértebra cervical, durante un tiempo algo mayor que 35 segundos. La prueba es positiva cuando se produce en el paciente un nistagmo de reojo o sensación vertiginosa. Al realizar esta prueba en 20 sujetos considerados normales, por consultar sólo por molestias faríngeas o nasales, no se produjeron alteraciones objetivas ni subjetivas. En 50 pacientes con la prueba de comprensión de las arterias vertebrales positivas se encontraron además, en un alto porcentaje, alteraciones en el examen otoneurológico o en los exámenes de laboratorio que apuntan a que existen alteraciones en las condiciones hemorreológicas que afectan la circulación de los vasos finos menores que 60 micrones. Con esto se pretende demostrar que la sola obstrucción de las arterias vertebrales no es suficiente para producir síntomas y signos vestibulares sino que, además es necesario una alteración que afecte la circulación fina del territorio afectado