Relevancia de la complementariedad clinicorradiológica en la siderosis superficial cerebral / Importance of the clinical-radiological complementarity in superficial cerebral siderosis

Se presentan dos casos de siderosis superficial del sistema nervioso central, idiopático en un caso y secundaria a hemorragia subaracnoidea de origen no identificado en el otro. Los síntomas que caracterizaron el cuadro clínico de ambos fueron el trastorno de la marcha y la hipoacusia. El estudio de resonancia magnética (RM), demostró un halo de hiposeñal que bañaba las superficies cerebrales, cerebelo, tronco del encéfalo y nervios craneales. Los hallazgos fueron más evidentes en la serie de spin echo potenciada en T2.La alta sensibilidad de la RM para la detección de depósitos de hemosiderina permitió el diagnóstico de esta infrecuente enfermedad (AU)

[Importance of the clinical-radiological complementarity in superficial cerebral siderosis]. / Relevancia de la complementariedad clinicorradiológica en la siderosis superficial cerebral.

We report two cases of superficial siderosis of central nervous system. In one case it was idiopathic and in the other secondary to an unidentified subarachnoid hemorrhage. The symptoms that characterized the clinical picture of both were gait disturbance and hypoacusis. The MRI study showed a superficial rim of hypointensity that covered the cerebellum and brainstem, and extended along the cranial nerves and the brain surface. The findings were clearer in the T2 spin echo series. Due to the high sensitivity for hemosiderin deposits, MRI made it possible to make the final diagnosis of this rare disease.

[Non tumoural cerebral biopsies: an analysis of 50 cases]. / Biopsias cerebrales no tumorales: an lisis de 50 casos.

OBJECTIVE: Cerebral biopsy is an invasive technique with limited, specific indications in view of the potential risk of complications. PATIENTS AND METHODS: We reviewed a series of 50 cases of biopsies via craniotomy done over a period of 10 years to investigate suspected non tumoural disorders. RESULTS: There was a predominance of space occupying lesions and treatable infections (36%) and of non diagnostic biopsies (40%). There was poor correlation between the initial clinical diagnosis and the histological findings (50 71%). There were no complications. CONCLUSIONS: We conclude that the indications should be better defined and, in view of the satisfactory tolerance of this procedure, the study group should be increased by using other less invasive procedures (stereotaxia).

[Spinal cord dural arteriovenous fistulae: analysis of a series with surgical curative treatment]. / Fístulas arteriovenosas durales espinales: análisis de una serie con tratamiento quirúrgico curativo.

BACKGROUND: Spinal dural arteriovenous fistulae (SDAVF) are elusive to an early diagnosis. Otherwise, there is no agreement regarding the best treatment. AIM: To review our series of spinal arteriovenous malformations to illustrate the treatment and outcome of FAVDE. PATIENTS AND METHODS: Descriptive series of cases diagnosed and treated at our hospital within the last ten years. Ten suspicious MRI, followed by angiograms, got the next diagnosis: 3 intraspinal malformations, 2 cavernoms and 5 FAVDE, reported here. RESULTS: Four out of 5 FAVDE were men. Mean age was 61year (53-77), and mean interval to diagnosis 10.8 months (1-24). The clinical course consisted of progressive paraparesis, wich was acute in one case, with wheelchair confinement. Sensory involvement and sphinter dysfunction were also always present; severe pain affected 2 cases. MRI revealed the FAVDE at low thoracic or lumbar levels, with tortuous flow voids over the surface of the affected area. Angiograms disclosed the single feeding vessel between D8-L3. Laminectomy and interruption of the draining vein was the chosen treatment. Postoperative complications were not found. Improvement followed until full recovery, that occurred in 4 cases. One patient, previously embolized, was the only one with just modest recovery, although the angiogram proved that deferred surgery ran well. Mean follow-up was 3.8 years (1.5-6); neither clinical deterioration nor suspicious MR finding were found. Postoperative angiogram, performed in two cases, confirmed the fistulae as occluded. CONCLUSIONS: FAVDE mainly involves old males with progressive paraparesis. Suitable MR findings and characteristic angiograms allow the diagnosis. Novel patients are subsidiary to selective and simple surgery, that is usually curative without recurrencies.

Fistulas arteriovenosas durales espinales: análisis de una serie con tratamiento quirúrgico curativo / Spinal cord dural arteriovenous fistulae: analysis of a series with surgical curative treatment

FUNDAMENTO: Las fístulas arteriovenosas durales espinales escapan a un diagnóstico temprano, sin que haya acuerdo acerca del mejor tratamiento. OBJETIVO: Revisar nuestra serie de malformaciones vasculares espinales e ilustrar el tratamiento y pronóstico de las fístulas arteriovenosas durales espinales. PACIENTES Y MÉTODOS: Serie descriptiva de casos diagnosticados y tratados en nuestro hospital en los últimos 10 años. Se realizaron 10 resonancias magnéticas sospechosas, seguidas de angiografía, que correspondían a tres malformaciones intraespinales, dos cavernomas y cinco fístulas arteriovenosas durales espinales, descritas aquí. RESULTADOS: Cuatro de las cinco fístulas arteriovenosas durales espinales se hallaron en varones. La media de edad era de 61 años (límites, 53-77) y el intervalo medio hasta el diagnóstico era de 10,8 meses (límites, 1-24). La paraparesia, de inicio agudo en un caso, fue siempre progresiva, terminando el paciente en silla de ruedas. Hubo siempre semiología esfinteriana y sensitiva, con algias acusadas en 2 casos. La resonancia magnética reveló la fístula arteriovenosa dural espinal en la zona torácica baja o lumbar, con imágenes tortuosas de vacío de señal sobre la superficie afectada. La angiografía puso de manifiesto un vaso aferente único entre D8-L3. El tratamiento elegido fue laminectomía seguida de ligadura del vaso de drenaje. No hubo complicaciones postoperatorias. En 4 casos se produjo una mejoría hasta recuperación completa. Un paciente, embolizado previamente, fue el único con recuperación pobre, aunque la angiografía demostró que la cirugía diferida había sido eficaz. El seguimiento medio fue de 3,8 años (límites, 1,5-6), sin deterioro clínico o hallazgos sospechosos en la resonancia magnética. La angiografía postoperatoria, realizada en 2 casos, confirmó la oclusión de la fístula. CONCLUSIONES: Los casos prevalentes de fístula arteriovenosa dural espinal son varones de edad avanzada con paraparesia espástica progresiva. Los hallazgos apropiados de resonancia magnética y una angiografía característica permiten el diagnóstico. Los pacientes nuevos son subsidiarios de cirugía selectiva y sencilla, que resulta curativa y sin recurrencias (AU)

BACKGROUND: Spinal dural arteriovenous fistulae (SDAVF) are elusive to an early diagnosis. Otherwise, there is no agreement regarding the best treatment. AIM: To review our series of spinal arteriovenous malformations to illustrate the treatment and outcome of FAVDE. PATIENTS AND METHODS: Descriptive series of cases diagnosed and treated at our hospital within the last ten years. Ten suspicious MRI, followed by angiograms, got the next diagnosis: 3 intraspinal malformations, 2 cavernoms and 5 FAVDE, reported here. RESULTS: Four out of 5 FAVDE were men. Mean age was 61year (53-77), and mean interval to diagnosis 10.8 months (1-24). The clinical course consisted of progressive paraparesis, wich was acute in one case, with wheelchair confinement. Sensory involvement and sphinter dysfunction were also always present; severe pain affected 2 cases. MRI revealed the FAVDE at low thoracic or lumbar levels, with tortuous flow voids over the surface of the affected area. Angiograms feeding disclosed the single vessel between D8-L3. Laminectomy and interruption of the draining vein was the closen treatment. Postoperative complications were not found. Improvement followed until full recovery, that occurred in 4 cases. One patient, previously embolized, was the only one with just modest recovery, a1though the angiogram proved that deferred surgery ran well, Mean follow-up was 3.8 years (1.5-6); neither clinical deterioration nor suspicious MR finding were found. Postoperative angiogram, performed in two cases, confirmed the fistule as occluded. CONCLUSIONS: FAVDE mainly involves old males with progressive paraparesis. Suitable MR findings and characteristic angiograms allow the diagnosis. Novel patients are subsidiary to selective and simple surgery, that is usually curative without recurrencies (AU)

Biopsias cerebrales no tumorales:análisis de 50 casos / Non-tumoural cerebral biopsies: an analysis of 50 cases

Objetivo. La biopsia cerebral es una técnica invasiva con indicaciones selectivas y restringidas por el potencial riesgo de complicaciones. Pacientes y métodos. Revisamos una serie de 50 casos de biopsias por craneotomía, reunidos en un intervalo de 10 años tras indicación por sospecha de patología no tumoral. Resultados. Predominan los hallazgos de procesos expansivos e infecciones tratables (36 por ciento) y los de muestras no diagnósticas (40 por ciento). La concordancia entre el diagnóstico clínico (de sospecha o de salida) y el histológico es baja (50-71 por ciento). No se registraron complicaciones. Conclusiones. Deben mejorarse las indicaciones y, dada la buena tolerancia, debería aumentarse la muestra mediante otros procedimientos menos invasivos (estereotaxia) (AU)