RESUMO
INTRODUCTION: Bilateral simultaneous facial palsy is a rare clinical entity. Traumatic origin is even rarer. Long-term sequelae are disabling. Therefore, rapid and adequate management is crucial. CASE PRESENTATION: Herein we present a case report of a traumatic bilateral facial palsy in a 43 years old male treated with surgery in one side and conservative treatment in the other side. He achieved eye closure at his 10 months follow up. DISCUSSION: Electroneurography showing more than 90 % of facial nerve degeneration and electromyography revealing no regeneration potentials are identified as surgical indications. The perigeniculate region is the most commonly injured portion of the facial nerve with temporal bone fractures. Surgical approach to this area remains controversial; transmastoid, middle fossa craniotomy or a combination of both. CONCLUSION: It is important to discuss expectations with the patient as it might take 12 months to regain maximal nerve function.
RESUMO
INTRODUCTION: Type1 Neurofibromatosis (NF1) is an autosomal dominant disorder with a great variety of clinical features. Vascular manifestations appear in less than 7%, and venous complications are extremely rare. CASE PRESENTATION: We report a case of an enormous cervical hematoma caused by bleeding from the internal jugular vein in a NF1 patient. As the patient refused surgery, natural evolution was marked by spontaneous fistulization and drainage of the mass. DISCUSSION: Several cases of fragility of both the vessel wall and the surrounding tissue are discussed and two jugular vein aneurysms were reported. Management of such cases remains unclear and some reports describe defective hemostatic control at surgery. CONCLUSION: Surgery in NF1 vascular involvement should be considered on a case by case basis especially when the risk of iatrogenesis is high. Surgeons need to be aware of hemorrhagic risks, which could occur because of vessel friability.
RESUMO
INTRODUCTION: Papillary carcinoma accounts for approximately 80% of all thyroid carcinomas. It is associated with relatively good survival. Distant metastases occur in approximately 10% of the patients, with the lung and bone being the most commonly reported sites. We present a case of unusual metastasis to the sphenoid bone and sella turcica from papillary thyroid carcinoma with an insular component. CASE PRESENTATION: We present a case of 70 years old female patient who presents a voluminous goiter with an 11 cm mass of the left sixth rib. Trans-parietal biopsy proved its metastatic origin from a thyroid papillary carcinoma. The patient was treated with total thyroidectomy and radiation therapy as the metastatic tissue is radioiodine refractory. Pathology revealed a papillary carcinoma with an insular component. A year later, the patient develops another metastasis to the sphenoid bone extending to the sella turcica, cavernous sinus, and carotid arteries. Treatment was based on kinase inhibitor. DISCUSSION: Metastatic invasion of the skull develops in 2.5%-5.8% of differentiated thyroid carcinoma and mostly affects the sella turcica, pituitary gland, cavernous sinus and sphenoid sinus. The presence of an insular component in a well-differentiated thyroid carcinoma seems to be associated with a poor prognosis. For cases where the metastatic disease is found to be resistant to conventional therapies, some clinical trials show promise with the use of tyrosine kinase inhibitors such as Sorafenib. CONCLUSION: Management of such uncommon cases remains challenging and should take in consideration evidence based guidelines, prognostic factors, disease progression path and treatment morbidity.
