Assuntos
Acidente Vascular Cerebral , Idoso , Emergências , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Estudos Prospectivos , População Rural , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Tunísia/epidemiologia , População UrbanaRESUMO
Meningeal carcinomatosis is an uncommon metastatic complication of systemic solid tumors. The diagnosis is based on the presence of malignant cells in the cerebrospinal fluid. The sensibility of cerebrospinal fluid testing in detecting the neoplastic cells improves when repeating lumbar punctures. Magnetic resonance imaging could help in establishing the diagnosis. The prognosis of carcinomatous meningitis is poor, especially when the primitive neoplasm is initially unknown. We report the case of a patient presenting with sudden bilateral visual decrease, headaches, and vomiting. Signs of meningeal irritation were found. Cerebrospinal fluid analysis showed malignant cells consistent with an adenocarcinoma. Abdominal echography and MRI concluded in a nodule of the cephalic portion of the pancreas. Carcinomatous meningitis rarely complicates pancreatic cancers.
RESUMO
Spinal tumors are rare; intramedullary tumors are uncommon among these lesions, and occur in only 10% of cases in adults. Ependymoma is the most frequent histological type (40-60%). We report the case of a 22-year-old girl, presenting with local back pain, ascendant paresthesia, a progressive flask paraparesis, and a vesical globe. The clinical examination concluded in a mild motor weakness with areflexia of both patellar and Achilles tendons. The diagnosis of intramedullary tumor was made on MRI. The radiological and the macroscopic aspects evoked an ependymoma; the diagnosis was histologically confirmed after surgery (myxopapillary ependymoma) with a favorable evolution.
