Mucocele of the Paranasal Sinuses - Retrospective Analysis of a Series of Seven Cases.

AIM: The present study aimed at identifying the risk factors, typical clinical symptoms and applied treatment in seven cases with mucocele of the paranasal sinuses. MATERIALS AND METHODS: Seven patients suffering from mucocele of the paranasal sinuses were admitted to the Clinic of Neurosurgery and the Clinic of Ear, Nose and Throat Diseases between 2014 and 2016. There were 4 females and 3 males aged between 22 and 78 (95% CI [31.44, 70.23]). Initial symptoms, their duration, clinical presentation upon admission, localization of the mucocele, type of surgical intervention and outcome have all been studied. RESULTS: The localization of the mucocele was frontal (2 cases), fronto-ethmoidal (2 cases), ethmoidal (1 case) and spheno-ethmoidal (2 cases). Risk factors were identified in 4 cases. Endoscopic marsupialization of the mucocele was performed in 5 cases. One patient with intracranial extension of frontal mucocele was treated via right frontobasal craniotomy. One of the patients refused surgery. CONCLUSION: Endoscopic marsupialization should be considered as a method of choice in cases with mucoceles without extensive intracranial invasion. This approach offers adequate drainage, balloon dilatation of the natural sinus openings that prevents future recurrence.

Modern imaging modalities in the assessment of acute stroke.

The aim of this review was to present the modern concepts of diagnostic imaging in acute stroke. Neuroimaging in acute stroke aims at diagnosing the condition as early as possible and assessing the extent of parenchymal perfusion and the intracranial vessels patency. A modern approach would involve a combination of various imaging modalities as multidetector computed tomography and high field magnetic resonance imaging. A non-enhanced computed tomography (CT) is used to detect hemorrhage or to identify early signs of ischemic stroke. CT angiography finds evidence of intravascular thrombi or significant stenoses, and CT perfusion displays brain tissue at risk of irreversible alterations that can be salvaged therapeutically. Magnetic resonance imaging (MRI) is a more sensitive modality than CT in diagnosing acute brain ischemia. MR diffusion-weighted imaging is more sensitive than conventional MR sequences in hyperacute stage. MR angiography as a non-invasive and non-ionizing imaging method is used as an alternative modality to CT angiography. To find brain tissue at risk diffusion- and perfusion-weighted magnetic resonance imaging modalities are used. The authors present briefly the modern neuroimaging modalities used in patients with transient ischemic attack, minor stroke and venous infarction. By combining different imaging techniques in a multimodal approach we can acquire the information necessary for therapeutic planning and differentiate patients who need thrombolysis.

Transient ischaemic attacks and minor strokes (analyses and clinically significant comparisons).

UNLABELLED: The transient ischaemic attacks (TIA) and minor strokes are independent predictors of disabling strokes with a high medical and social value. PURPOSE: Analysis and comparison of the data from the clinical monitoring of TIA and minor stroke patients in correlation with the different duration of the transient neurological deficit. PATIENTS AND METHODS: 234 patients were monitored clinically in the Clinic of Cerebrovascular Diseases, University Hospital "St. George"-Plovdiv between 2002 and 2004. Clinical data were collected for 79 patients who met the clinical criteria for TIA and 155 patients who met the clinical criteria for minor stroke. Our protocol included medical history, cardiac and neurological examinations, assessment of cerebrovascular risk factors and laboratory tests. The instrumental assessment included CT scan, MRI and Doppler examination. The data were processed using descriptive statistics, non-parametric methods and charts. RESULTS: The comparative analysis between the TIA and minor stroke patients shows a significant difference only in the number of registered conductive disturbances, which are more frequent in the TIA patients. In the TIA group the significantly more frequent features are acute onset of the neurological deficit, significantly more frequent normal CT scan images or lacunar infarctions findings. In the minor stroke group the significantly more frequent features are the subacute onset, more frequent CT findings of vascular encephalopathy or CT scans revealing one large ischaemic zone. CONCLUSIONS: The differences may be explained with the dominant pathogenetic mechanisms in each of the conditions: microembolisation of extracranial vascular origin in TIA and local thrombosis or cardioembolisation in minor stroke. Previous vascular damage in minor stroke patients is more evident.

Optimal computed tomographic (CT) examination technique for microendoscopic sinus surgery.

AIM: Functional endoscopic sinus surgery is widely utilized to assess and treat inflammatory sinonasal diseases. The use of this surgical technique has resulted in a dramatic increase of the radiologic studies carried out as part of presurgical preparation. Computed tomography (CT) has become a standard for pre-endoscopic and postoperative assessment of the paranasal sinuses. In our study we aimed at finding the optimal imaging technique for CT examination of the sinuses. MATERIALS AND METHODS: We examined 60 patients with inflammatory sinonasal diseases using Sytec 3000 CT scanner. The scans were performed in the coronal and axial plane. The kilovolt peak was kept constant and the milliampere second setting was reduced without image compromise. CONCLUSION: CT study is a method of choice in diagnosing inflammatory diseases of the sinuses. The technique we suggest in the study provides maximal diagnostic information at reduced cost and radiation exposure of the patient.