ABSTRACT
INTRODUCTION: Polymer-coats may peel-off the surface of catheters and devices during endovascular procedures and might lead to brain inflammatory foreign-body reactions. METHODS: We conducted a retrospective, descriptive, single-centre study including all patients with symptomatic intracranial oedematous and contrast-enhancing lesions after any neurointerventional procedure performed in our hospital between 2013 and 2019. RESULTS: From a total of 7446 neurointerventional procedures, 11 cases were identified (9 female, 2 male, median age 47 year-old), with an incidence of 0.14 %. The procedures were therapeutic in all: ten aneurysm embolization/isolation, one acute ischaemic stroke recanalization. Intracranial coils, stent or both were placed in all. Symptoms appeared during the following one day to fourteen months (median of 4.2 weeks). Brain MRI showed oedematous, contrast-enhancing lesions scattered through the vascular territory of the canalized vessel. Brain biopsy confirmed the diagnosis in one case and was supportive in another one. Eight patients received immunosuppression. No treatment was started in two. After a median time of follow-up of 3.5 years, five patients are totally asymptomatic. One patient presents slight weakness. Four patients have remote symptomatic seizures, but they have comorbid lesions (previous stroke, intracranial haemorrhage, biopsy needle-track's gliosis). Follow-up MRI showed significant improvement in all the cases, with complete resolution in five. Non-symptomatic lesion fluctuation was observed in three cases. Two patients experienced symptomatic rebounds. CONCLUSION: Intracranial embolic foreign-body symptomatic reactions are uncommon complications of neurointerventional procedures. Diagnostic angiographies might have lower risk of polymer-embolization than therapeutic procedures. This entity's early recognition enables making proper diagnosis and treatment decisions.
Subject(s)
Endovascular Procedures/adverse effects , Foreign-Body Reaction/diagnostic imaging , Intracranial Embolism/diagnostic imaging , Neurosurgical Procedures/adverse effects , Postoperative Complications/diagnostic imaging , Tertiary Care Centers , Adult , Endovascular Procedures/instrumentation , Female , Foreign-Body Reaction/etiology , Foreign-Body Reaction/surgery , Humans , Intracranial Embolism/etiology , Intracranial Embolism/surgery , Male , Middle Aged , Neurosurgical Procedures/instrumentation , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective StudiesSubject(s)
Intracranial Arteriosclerosis/complications , Neurofibromatosis 1/complications , Siderosis/complications , Adult , Humans , Intracranial Arteriosclerosis/diagnostic imaging , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Neurofibromatosis 1/diagnostic imaging , Siderosis/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Two patients with a syndrome of pandisautonomia with clinical criteria of AAG are provided. Both patients present a similar clinical picture and response to immunosuppressive treatment. One of them has positive antibodies against the ganglionic nicotinic acetylcholine (gAChr) and the other does not. This brief article serves to reflect the spectrum of AAG, at a clinical level, in laboratory tests and in the response to immunotherapy, independently of the presence of positive gAChr antibodies.
Subject(s)
Autoimmune Diseases of the Nervous System/drug therapy , Autoimmune Diseases of the Nervous System/immunology , Immunoglobulins, Intravenous/therapeutic use , Primary Dysautonomias/drug therapy , Primary Dysautonomias/immunology , Adult , Autoantibodies/immunology , Autoantigens/immunology , Humans , Male , Middle AgedABSTRACT
In this case report, we describe a patient who has a persistent left superior vena cava (PLSVC) manifesting as a transient ischemic attack (TIA) and a remote brain abscess. PLSCV, when draining in the left atrium, is a cause of right to left shunt, and it has been related to brain abscesses and, as reported in a few cases, to ischemic stroke. After admission, our patient experienced 2 new episodes of TIA while being injected with agitated saline contrast through the left arm, producing echocardiographic images of right to left shunt, which gave the clue to the diagnosis.
Subject(s)
Contrast Media/adverse effects , Echocardiography , Ischemic Attack, Transient/etiology , Sodium Chloride/adverse effects , Vascular Malformations/diagnostic imaging , Vena Cava, Superior/abnormalities , Administration, Intravenous , Echocardiography/methods , Humans , Male , Middle Aged , Vascular Malformations/complications , Vena Cava, Superior/diagnostic imagingABSTRACT
Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system caused by JC virus. Only ten cases of PML have been reported so far in liver transplant recipients. We present a case of liver posttransplantation PML with characteristic clinical and brain MRI findings, but with an atypical late onset, developed 11 years after transplantation and after single-drug, long-term (8 years), and low-dose (750 mg twice a day) immunosuppression with mycophenolate mofetil (MMF). This is the latest onset of PML associated to liver transplant reported. The present case should help physicians to be aware of PML after transplantation, even in the long term and even under low doses of immunosuppressants, especially MMF.
