ABSTRACT
BACKGROUND AND OBJECT: Delayed haemorrhage in the splenium of the corpus callosum after aneurysm rupture is a rare finding. It can be defined as a haemorrhage not present at the initial diagnosis of subarachnoid bleeding, in the context of an aneurysm not located in the corpus callosum vascularization. Only three such cases have been reported, all with focal and circumscribed haematomas. We describe a case of diffuse haemorrhage along the splenium fibres. PATIENT: A 75-year-old woman was attended for an acute cognitive deterioration. Imaging studies revealed an aneurysm in the anterior communicating artery, and subacute haematomas in both frontal lobes. An uneventful surgical clipping of the aneurysm was performed. Postoperative CT-scans showed a haemorrhage along the splenium fibres, and hydrocephalus. A ventriculoperitoneal shunt was placed, and subsequent CT scans demonstrated progressive, spontaneous improvement of the splenium haemorrhage. CONCLUSIONS: Delayed haemorrhage in the splenium of the corpus callosum has a sporadic incidence. Physiopathology is unknown, and proposed explanations include compression of the splenium against the falx due to hydrocephalus, and haemorrhagic transformation of an ischaemic infarct due to vasospasm. Treatment is therefore based on adequate treatment of hydrocephalus and discontinuation of vasodilator drugs. The three previous cases of focal haematomas are discussed, and the first case of diffuse haemorrhage is described.
Subject(s)
Aneurysm, Ruptured/complications , Corpus Callosum , Intracranial Hemorrhages/etiology , Subarachnoid Hemorrhage/complications , Aged , Aneurysm, Ruptured/surgery , Cerebral Angiography , Cognition Disorders/complications , Female , Frontal Lobe/pathology , Humans , Intracranial Hemorrhages/surgery , Subarachnoid Hemorrhage/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
STUDY DESIGN: We describe an unusual cause of myelopathy with a discussion of similar cases previously reported in the literature. OBJECTIVE: To report a case of myelopathy due to intradiscal gouty tophus. SUMMARY OF BACKGROUND DATA: Spinal involvement in gout is uncommon. Cervical spinal cord compression caused by gout is particularly rare. METHODS: We report the case of a 71-year-old man with a history of hyperuricemia gout. Spastic quadriparesis developed for more than 4 months. Magnetic resonance image of the cervical spine revealed a herniated cervical disc at the C3-C4 level. Anterior discectomy was performed. Intradiscal chalky white granular material was found during surgery. RESULTS: Histological examination of the surgical specimen demonstrated a gouty tophus. The patient regained strength in all extremities in the postoperative period and required rehabilitation treatment. CONCLUSION: Spinal gout should be considered in all patients presenting myelopathy and history of gout. When progressive neurological symptoms develop, surgical decompression can provide a satisfactory outcome.
