ABSTRACT
Ophthalmoplegic migraine is a rare syndrome in which headache is associated with ophthalmoplegia and third, fourth or sixth cranial nerves palsy. It occurs most frequently in childhood and teenagers. At magnetic resonance imaging (MRI) with gadolinium (GD-DTPA) it may be observed a transitory enhancement of the affected nerve. We present the case of a male teenager, 16 years old, with typical medical history and enhanced signal at left oculomotor nerve in cisternal portion at MRI weighted in T1 with GD-DTPA. On the control exam, eighteen months later, there was no remarkable lesion. The enhancement of oculomotor nerve at MRI is always pathological and among the differential diagnosis we must include: neoplasia (lymphoma and leukemia), infections (AIDS, syphilis), inflammatory process (sarcoidose and Tolosa-Hunt syndrome) and vascular (posterior communicating artery aneurysm).
Subject(s)
Migraine Disorders/complications , Ophthalmoplegia/complications , Adolescent , Anti-Inflammatory Agents/therapeutic use , Gadolinium DTPA , Humans , Magnetic Resonance Angiography , Male , Migraine Disorders/drug therapy , Ophthalmoplegia/diagnosis , Ophthalmoplegia/drug therapy , Prednisone/therapeutic useABSTRACT
Apresentamos imagens de tomografia computadorizada de um paciente de 83 anos de idade com histiocitoma fibroso benigno profundo, na face lateral da perna esquerda, com evolução de longa data. A tomografia computadorizada observamos massa bem delimitada, ovalada, e que apresentava intenso realce periférico com uso do meio de contraste iodado. Este é um tumor de partes moles pouco freqüente e com raros relatos dos seus aspectos de imagem.
Subject(s)
Humans , Male , Aged, 80 and over , Histiocytoma, Benign Fibrous , Histiocytoma, Benign Fibrous/diagnosis , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms , Leg , Tomography, X-Ray ComputedABSTRACT
A enxaqueca oftalmoplégica é síndrome rara em que a cefaléia se associa à oftalmoplegia por paralisia do terceiro, quarto ou sexto nervos cranianos. Ocorre mais freqüentemente em crianças e adolescentes. Ao exame de ressonância magnética (RM), com uso de gadolínio, é observado realce transitório do nervo afetado. Apresentamos o caso de um adolescente, 16 anos, masculino, com história típica e hipersinal nas seqüências ponderadas em T1 pós-infusão venosa do gadolínio na porção cisternal do nervo oculomotor esquerdo. No exame de controle, realizado 18 meses depois, houve remissão completa das alterações na RM. O hipersinal do oculomotor à RM é sempre patológico; entre os diagnósticos diferenciais devemos incluir neoplasias (linfoma, leucemia), infecções (SIDA, sífilis), doenças inflamatórias não-infecciosas (sarcoidose, síndrome de Tolosa-Hunt) e vasculares (aneurisma da artéria comunicante posterior).
Subject(s)
Adolescent , Humans , Male , Migraine Disorders/complications , Ophthalmoplegia/complications , Anti-Inflammatory Agents/therapeutic use , Gadolinium DTPA , Magnetic Resonance Angiography , Migraine Disorders/drug therapy , Ophthalmoplegia/diagnosis , Ophthalmoplegia/drug therapy , Prednisone/therapeutic useABSTRACT
A síndrome de Hallervorden-Spatz é afecção neurodegenerativa, autossômica recessiva com duas apresentações clínicas: precoce e tardia. Esta última é caracterizada pelo acometimento psiquiátrico e a presença de sinais piramidais e extrapiramidais. Relatamos o caso de mulher de 41 anos, com história de alterações extrapiramidais. O exame de ressonância magnética (RM) mostrou o sinal dos olhos-de-tigre, lesão dos globos pálidos mediais com deposição de ferro periférica (hipo-sinal) e gliose central (hipersinal), nas seqüências com tempo de repetição (TR) longo. Há forte relação entre o sinal na RM e mutações no gene responsável pela lesão, fazendo deste exame sensível o suficiente para a realização do diagnóstico da doença.
Subject(s)
Humans , Female , Adult , Magnetic Resonance Imaging , Pantothenate Kinase-Associated Neurodegeneration , Diagnosis, Differential , Iron/metabolism , Pantothenate Kinase-Associated NeurodegenerationABSTRACT
Hallervorden-Spatz syndrome is a neurodegenerative disease, autosomic recessive with two clinical features: early and late onset. Psychiatric, pyramidal and extrapyramidal signs are present in the late subtype. We report the case of a 41-old woman with extrapyramidal signs. Magnetic resonance imaging (MRI) showed the eye-of-the-tiger sign in the medial globus pallidus. This is due to a gliosis (increased signal) and accumulation of surrounding iron (decreased signal intensity) in long TR sequences. There is a strong relationship between MRI findings and the gene mutation responsable for this disease. It makes the MRI sensible for diagnosing this syndrome.
Subject(s)
Magnetic Resonance Imaging , Pantothenate Kinase-Associated Neurodegeneration/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Iron/metabolism , Pantothenate Kinase-Associated Neurodegeneration/etiologyABSTRACT
Necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1 porcentage of splenectomies. It is more frequent when the removal of the spleen is done because of hematological disease. Its mortality index can reach 60 porcentage and its pathogenisis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variantions can cause a predisposition towards the appearance of potentially ischemic areas, especially afterligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnose in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patien's clinic status. The objective of this study was to report on the case of a patient submitte to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this complication are needed to reduce its mortality rate.
