ABSTRACT
BACKGROUND AND PURPOSE: Transverse sinus stenosis can lead to pseudotumor cerebri syndrome by elevating the cerebral venous pressure. The occipital emissary vein is an inconstant emissary vein that connects the torcular herophili with the suboccipital veins of the external vertebral plexus. This retrospective study compares the prevalence and size of the occipital emissary vein in patients with pseudotumor cerebri syndrome with those in healthy control subjects to determine whether the occipital emissary vein could represent a marker of pseudotumor cerebri syndrome. MATERIALS AND METHODS: The cranial venous system of 46 adult patients with pseudotumor cerebri syndrome (group 1) was studied on CT venography images and compared with a group of 92 consecutive adult patients without pseudotumor cerebri syndrome who underwent venous assessment with gadolinium-enhanced 3D-T1 MPRAGE sequences (group 2). The presence of an occipital emissary vein was assessed, and its proximal (intraosseous) and distal (extracranial) maximum diameters were measured and compared between the 2 groups. Seventeen patients who underwent transverse sinus stent placement had their occipital emissary vein diameters measured before and after stent placement. RESULTS: Thirty of 46 (65%) patients in group 1 versus 29/92 (31.5%) patients in group 2 had an occipital emissary vein (P < .001). The average proximal and distal occipital emissary vein maximum diameters were significantly larger in group 1 (2.3 versus 1.6 mm, P <.005 and 3.3 versus 2.3 mm, P < .001). The average maximum diameters of the occipital emissary vein for patients who underwent transverse sinus stent placement were larger before stent placement than after stent placement: 2.6 versus 1.8 mm proximally (P < .06) and 3.7 versus 2.6 mm distally (P < .005). CONCLUSIONS: Occipital emissary veins are more frequent and larger in patients with pseudotumor cerebri syndrome than in healthy subjects, a finding consistent with their role as collateral venous pathway in transverse sinus stenosis. A prominent occipital emissary vein is an imaging sign that should raise the suspicion of pseudotumor cerebri syndrome.
Subject(s)
Cerebral Veins/pathology , Pseudotumor Cerebri/pathology , Adult , Cranial Sinuses/pathology , Female , Humans , Imaging, Three-Dimensional , Male , Pseudotumor Cerebri/etiology , Retrospective StudiesABSTRACT
Thoracic vertebral arteries are anastomotic chains similar to cervical vertebral arteries but found at the thoracic level. Descending thoracic vertebral arteries originate from the pretransverse segment of the cervical vertebral artery and curve caudally to pass into the last transverse foramen or the first costotransverse space. Ascending thoracic vertebral arteries originate from the aorta, pass through at least 1 costotransverse space, and continue cranially as the cervical vertebral artery. This report describes the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Being located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries can have important implications during spine interventional or surgical procedures. Because they frequently provide radiculomedullary or bronchial branches, they can also be involved in spinal cord ischemia, supply vascular malformations, or be an elusive source of hemoptysis.
Subject(s)
Vertebral Artery/abnormalities , Angiography , Female , Humans , Male , Thoracic Vertebrae , Vertebral Artery/diagnostic imagingABSTRACT
El HPTP es una patología muy frecuente que a menudo cursa de manera asintomática. Siendo la intervención quirúrgica el único tratamiento curativo de la enfermedad, existen unos criterios de indicación de cirugía que no siempre se ajustan a la realidad del paciente, pues se basan en la existencia de complicaciones clínicas (osteoporosis, insuficiencia renal, urolitiasis, fracturas por fragilidad). Presentamos el caso clínico de una paciente que no cumplía ninguno de los requisitos para ser intervenida quirúrgicamente según los documentos de posición, y que fue operada tras demostrarse la existencia de un deterioro de la estructura trabecular ósea, determinada por la técnica TBS (trabecular bone score), y localizarse el adenoma por gammagrafía. Se discute la posible utilidad de estas técnicas, no observadas en los documentos de posición, como complemento de la decisión de cirugía (AU)
HPTP is a very frequent pathology which often develops asymptomatically. Surgical intervention being the only curative treatment for this disease there are some criteria for the indication of surgery, but these do not always fit the reality of the patient since they are based on clinical complications (osteoporosis, renal insufficiency, urolithiasis, fragility fractures). We present the clinical case of a patient who did not meet any of the requirements for having surgical intervention according to the position documents, and who was operated on after the existence was shown of a deterioration of the trabecular bone structure, determined by the TBS (trabecular bone score) technique, and located in the adenoma using gammagraphy. The possible use of these techniques, not seen in the position documents, to complement the decision regarding surgery, is discusse (AU)
Subject(s)
Female , Humans , Middle Aged , Hyperparathyroidism, Primary/surgery , Densitometry/methods , Parathyroidectomy , Patient Selection , Radionuclide ImagingABSTRACT
During the past recent years, Enterobacteriaceae have supplanted Gram-positives in terms of frequent resistant bacteria seen in the outpatent setting. This change involves common opportunistic pathogens such as E. coli and K. pneumoniae. It is mainly due to the appearance and dissemination of extended-spectrum beta-lactamases (ESBL), that hydrolyse penicillins and cephalosporins. Bacteria producing these enzymes are often also resistant to quinolones and trimethoprime-sulfamethoxazole. This article, illustrated by a clinical case, presents the current epidemiology of ESBL-producing Enterobacteriaceae and the possible prevention measures and treatment options to fight the growing number of infections that they are causing.
Subject(s)
Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Escherichia coli Infections/drug therapy , beta-Lactamases , Drug Resistance, Bacterial , Escherichia coli/drug effects , Escherichia coli/enzymology , Humans , Male , Middle AgedABSTRACT
In presence of immunosuppression Cytomegalovirus (CMV) infection can cause severe and potentially fatal infection involving multiple organs. In healthy immunocompetent individuals CMV usually causes an asymptomatic or mild infection with spontaneous cure. No specific therapy is needed. Rarely, however, the primary infection can be severe with multiple organs injuries and fatal cases are described. In these situations antiviral therapy is indicated and the clinical and biological response is very rapidly good. We describe a clinical case and present a review of the literature.
Subject(s)
Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Immunocompetence , Adult , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/drug therapy , Female , Humans , Severity of Illness IndexABSTRACT
A stenosis of the internal carotid artery may cause 10-20% of all ischemic strokes. In symptomatic patients, carotid revascularization is indicated in the presence of a stenosis 50%. in asymptomatic patients, the indication for revascularization based on randomized trials is given at > or = 60% stenosis, as long as the estimated perioperative death or stroke risk is < 3%. In clinical practice however, asymptomatic stenoses are usually treated only if luminal narrowing exceeds 70-80%. The choice of the revascularization strategy (endarterectomy versus stenting) should be based on the surgical risk profile of the patient and on the locally available expertise. Carotid artery stenting is particularly beneficial in patients at high risk for surgery.
