Contrast-induced nephropathy: A dilemma between loss of neurons or nephrons in the setting of endovascular treatment of acute ischemic stroke.

PURPOSE: The aim is to report the incidence and risk factors of contrast-induced nephropathy after the use of iodine-based contrast for the endovascular treatment of acute ischemic stroke. METHODS: Data from patients who underwent neuroendovascular procedures in a center over a period of 22 months were analysed retrospectively. Contrast-induced nephropathy was determined by an increase in serum creatinine level of >25% of baseline or an absolute increase in serum creatinine level of at least 44 µmol/L (0.50 mg/dL) occurring after intravascular administration of contrast media without alternative explanation. The primary outcome measure of this study was the presence of contrast-induced nephropathy in these treated patients. Continuous data were presented as mean ± standard deviation, and categorical data as frequencies or percentages. The comparison was made using Student's t-test or Fisher's test. Logistic regression was performed to find independent contrast-induced nephropathy predictors. All statistical analyses were performed using Microsoft Excel. A p value of less than 0.05 was considered statistically significant. RESULTS: One hundred and eighty-nine patients undergoing endovascular treatment for acute ischemic stroke. Twenty cases of the total cohort (n = 189) presented contrast-induced nephropathy (10.58%). Only diabetes and creatinine levels between 1.3 and 2.5 mg/dL were associated with contrast-induced nephropathy. No patient was treated with dialysis. CONCLUSION: Contrast-induced nephropathy is a relatively common complication after endovascular treatment of acute ischemic stroke and is associated with worse outcome in patients with this condition. However, there is no increase in the frequency of hemodialysis after the use of iodinated contrast medium.

Cordoma cervical paravertebral, entidad que debemos conocer. A propósito de un caso / Cervical paraspinal chordoma, a condition we should know. A case report

El cordoma es un tumor raro de lento crecimiento, derivado de remanentes de la notocorda. La mayoría se localizan en la base del cráneo y en la región sacrococcígea, mostrando una localización cervical en solo el 6% de los casos. Presentamos el caso, poco frecuente (se han reportado menos de 10 en la literatura), de un cordoma paravertebral izquierdo, localizado a nivel de C2-C4, en un varón joven sin antecedentes personales de interés. Los hallazgos radiológicos sugerían que se trataba de una neoplasia de crecimiento lento, de predominio quístico, que erosionaba estructuras óseas y englobaba a la arteria vertebral izquierda. Se planificó exéresis quirúrgica y en el análisis de la pieza se observó proliferación celular con estroma de aspecto mixo-condroide, células epitelioides y fisalíferas (PAS+), todo ello compatible con cordoma

Chordoma is a rare, slow-growing tumour arising from remnants of the notochord. It is most often located in the base of the skull and the sacrococcygeal region, being located in the cervical region in only 6% of cases. A rare case is presented of a left para-spinal chordoma, of which less than 10 cases have been reported in literature. It was located at C2-C4 level in a young male with no personal history of interest. Radiographic findings suggested that this was a slow-growing tumour, of cystic dominance, which eroded the bone structures and encompassed the left vertebral artery. Surgical excision was performed, and in the analysis of the surgical piece, cell proliferation was observed, with a stromal myxoid-chondroid appearance, epithelioid and physaliphorous (PAS+) cells, all of them compatible with chordoma

Hematoma intraorbitario secundario a hiperémesis gravídica / Intraorbital hematoma secondary to hyperemesis gravidarum

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[Cervical paraspinal chordoma, a condition we should know. A case report]. / Cordoma cervical paravertebral, entidad que debemos conocer. A propósito de un caso.

Chordoma is a rare, slow-growing tumour arising from remnants of the notochord. It is most often located in the base of the skull and the sacrococcygeal region, being located in the cervical region in only 6% of cases. A rare case is presented of a left para-spinal chordoma, of which less than 10 cases have been reported in literature. It was located at C2-C4 level in a young male with no personal history of interest. Radiographic findings suggested that this was a slow-growing tumour, of cystic dominance, which eroded the bone structures and encompassed the left vertebral artery. Surgical excision was performed, and in the analysis of the surgical piece, cell proliferation was observed, with a stromal myxoid-chondroid appearance, epithelioid and physaliphorous (PAS+) cells, all of them compatible with chordoma.

Unprotected carotid artery stenting in symptomatic elderly patients: a single-center experience.

BACKGROUND AND PURPOSE: Surgery is known to have fewer adverse events in patients aged >75 years with carotid stenosis, but some are not candidates due to comorbidity. Stenting using protection devices is the most accepted endovascular technique. Our aim is to show the safety and efficacy of carotid stenting without any protection device in these patients. MATERIAL AND METHODS: All patients older than 75 years with carotid stenosis treated in our center between January 2002 and December 2012 were included in this prospective study. All were treated by carotid stenting without protection devices. Angiographic results, neurologic complications and Doppler ultrasound were collected during the procedure and within 30 days. RESULTS: 49 patients were included (mean age 78.2 years, range 75-86). The average degree of stenosis was 88.2%. During the procedure there were two cases of transient ischemic attack and one intraparenchymal hemorrhage. At 30 days there was a non-disabling stroke. The combined rate of disabling stroke plus myocardial infarction plus death was 6% at 30 days and the rate of any stroke was 4% during the procedure and 2% at 30 days. CONCLUSIONS: Endovascular treatment of carotid stenosis without protection devices in symptomatic patients aged >75 years is an alternative to endovascular treatment with protection devices. Complications and mortality rates are similar to studies that used protection devices in lower risk patients.

Appropriateness of lumbar spine magnetic resonance imaging in Spain.

OBJECTIVES: To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice. METHODS: LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as "appropriate", "uncertain" or "inappropriate" based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one "red flag" were classified as "appropriate". A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription. RESULTS: Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists' assessment with this classification was substantial (k=0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)]. CONCLUSION: Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes.

Síndrome de Lemierre: trombosis de seno cavernoso y oclusión de arteria carótida interna secundarios a sinusitis esfenoidal aguda / Lemierre syndrome: thrombosis of the cavernous sinus and internal carotid artery occlusion secondary to acute sphenoid sinusitis

El síndrome de Lemierre (SL) consiste típicamente en una tromboflebitis séptica de la vena yugular interna causada por Fusobacterium necrophorum. Presentamos una variante excepcional del SL con trombosis del seno cavernoso y oclusión de la carótida interna ipsilateral secundaria a una sinusitis esfenoidal causada por Streptococcus viridans (AU)

Lemierre syndrome (LS) typically consists of a septic thrombophlebitis of the internal jugular vein caused by Fusobacterium necrophorum. We present an unusual variant of LS with cavernous sinus thrombosis and occlusion of the ipsilateral internal carotid artery secondary to sphenoid sinusitis caused by Streptococcus viridans (AU)

Tratamiento endovascular prequirúrgico de la estenosis carotídea sintomática provocada por un meningioma del plano esfenoidal / Presurgical endovascular treatment of symptomatic carotid stenosis caused by a meningioma of the planum sphenoidale

Introducción. El infarto cerebral es una forma muy poco frecuente de presentación de un meningioma. Esta forma de inicio clínico plantea el reto de tratar los eventos isquémicos antes del abordaje quirúrgico de la tumoración. Caso clínico. Mujer de 48 años, natural de Georgia, que consultó por pérdida de fuerza en el hemicuerpo derecho, cefalea intensa y episodios autolimitados de olvido de su idioma. Se realizó tomografía computarizada craneal que mostraba un proceso expansivo frontal izquierdo y lesiones hipodensas en el núcleo caudado izquierdo. La evolución de la paciente fue desfavorable, presentando episodios de deterioro neurológico con hemiparesia derecha y afasia, alternados con períodos de mejoría. La resonancia magnética y el estudio angiográfico demostraron la oclusión tumoral de la arteria cerebral media izquierda secundaria a meningioma clinoideo. El tratamiento fue la recanalización de la arteria cerebral media por vía endovascular y posterior extirpación quirúrgica del meningioma. Conclusión. El tratamiento endovascular mediante angioplastia, previa a la exéresis quirúrgica del tumor, es una técnica adecuada para disminuir la incidencia de los eventos isquémicos(AU)

Introduction. Cerebral infarction is a very rare presenting symptom of a meningioma. This form of clinical onset poses the challenge of treating ischaemic events before dealing with the tumour surgically. Case report. A 48-year-old woman from Georgia who visited due to loss of strength in the right-hand side of the body, intense headache and self-limiting episodes of forgetting her own language. Computerised axial tomography scans of her head revealed a left frontal expansive process and hypodense lesions in the left caudate nucleus. The patient underwent an unfavourable progression, with episodes of neurological deterioration and hemiparesis of the right-hand side and aphasia, which alternated with periods of improvement. Magnetic resonance imaging and an angiographic study revealed tumour occlusion of the left middle cerebral artery, secondary to a clinoidal meningioma. Treatment involved endovascular recanalisation of the middle cerebral artery and later surgical removal of the meningioma. Conclusions. Endovascular treatment by means of angioplasty, prior to the surgical excision of the tumour, is a technique that enables the incidence of ischaemic events to be diminished(AU)

[Lemierre syndrome: thrombosis of the cavernous sinus and internal carotid artery occlusion secondary to acute sphenoid sinusitis]. / Síndrome de Lemierre: trombosis de seno cavernoso y oclusión de arteria carótida interna secundarios a sinusitis esfenoidal aguda.

Lemierre syndrome (LS) typically consists of a septic thrombophlebitis of the internal jugular vein caused by Fusobacterium necrophorum. We present an unusual variant of LS with cavernous sinus thrombosis and occlusion of the ipsilateral internal carotid artery secondary to sphenoid sinusitis caused by Streptococcus viridans.

Paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe: a propósito de un caso / Tympanic paraganglioma with extension into the Eustachian tube and nasopharynx: a case report

Los paragangliomas timpánicos suelen presentarse como una masa hipervascular en oído medio, siendo los síntomas de presentación más frecuentes acúfeno pulsátil e hipoacusia. Presentamos un caso infrecuente de recidiva de paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe, que se manifestó con epistaxis recurrente(AU)

Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis(AU)

Mielopatía compresiva como forma de presentación de una fractura transdiscal de bloque vertebral en una paciente con espondilitis anquilosante / Compressive myelopathy as the presentation form of a transdiscal fracture of the vertebrae in a patient with ankylosing spondylitis

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Tympanic paraganglioma with extension into the Eustachian tube and nasopharynx: a case report.

Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis.

Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus.

OBJECTIVE: To describe the clinical picture and treatment of dural arteriovenous fistulas (DAVFs) presenting as pulsatile subjective tinnitus. STUDY DESIGN: Review of prospectively collected data. SETTING: Academic referral center. PATIENTS: Fourteen patients with clinically and radiographically diagnosed DAVFs. INTERVENTIONS: Treated by endovascular route. MAIN OUTCOME MEASURES: Treatments, clinical course, complications, and evolution were evaluated. RESULTS: All patients presented with sleep-disruptive pulsatile tinnitus. Other symptoms included severe headaches, papilledema, proptosis, blepharoptosis, visual disturbances, and hemiparesis. Cortical venous drainage was present in 4 cases. Endovascular treatment was performed at least once by the arterial route in 14 patients and the venous route in 4 patients. The origin of tinnitus was always a vessel in or above the petrous bone. When these arteries or veins could not be visualized in the final control, the tinnitus disappeared. In the patients whose tinnitus returned, a vessel in the petrous bone could always be seen. There was no mortality. CONCLUSION: Endovascular treatment is an effective and safe treatment of DAVFs presenting as tinnitus.

Glucocorticoides e inmunoglobulinas en el síndrome de distrés respiratorio agudo secundario a neumonía por varicela / Glucocorticoids and immunoglobulins in an acute respiratory distress syndrome secondary to varicella pneumoniae

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