RESUMO
Cerebral vasculitis is diagnosed with difficulty. Its presentation with heterogeneous symptoms and signs often delays diagnosis. In this context, imaging plays an important role in advancing the diagnosis. Digital subtraction cerebral angiography, MRI, and MRA, the most useful examinations for vasculitis, provide supportive, but not pathognomonic, evidence of cerebral vasculitis. On MRI, multiple infarcts in different vascular territories and of different ages are suggestive of vasculitis. On digital subtraction cerebral angiography, areas of stenosis, dilatation, and occlusion are suggestive of vasculitis. Small vessel vasculitis is currently best demonstrated by changes seen in brain parenchyma on MRI, but high field strength (7 T) magnetic resonance angiography offers the possibility of directly evaluating small vessel vasculitis. Ultrasound and high-resolution contrast MRI are excellent modalities for evaluating the superficial extracranial circulation.
Assuntos
Vasculite do Sistema Nervoso Central/diagnóstico , Fatores Etários , Angiografia Digital , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Angiografia Cerebral , Infarto Cerebral/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Angiografia por Ressonância Magnética , Ultrassonografia Doppler em Cores , Vasculite do Sistema Nervoso Central/patologiaRESUMO
Disseminated mucormycosis, with pulmonary and cerebral angioinvasive disease, developed in a 65-year-old woman with rheumatoid arthritis being treated with combination immunosuppression including adalimumab. Clinical presentation included progressive orbital ischaemia. To the best of the authors' knowledge, this is the first reported case of disseminated mucormycosis in a patient treated with a tumour necrosis factor inhibitor. Important pathophysiological factors are considered.
Assuntos
Fungemia/etiologia , Imunossupressores/uso terapêutico , Isquemia/etiologia , Mucormicose/etiologia , Órbita/irrigação sanguínea , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Idoso , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Artrite Reumatoide/tratamento farmacológico , Encefalopatias/diagnóstico , Encefalopatias/etiologia , Quimioterapia Combinada , Evolução Fatal , Feminino , Fungemia/diagnóstico , Humanos , Terapia de Imunossupressão , Isquemia/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/etiologia , Angiografia por Ressonância Magnética , Mucormicose/diagnóstico , Artéria Oftálmica/patologia , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Radiological evidence of pneumatization of the intraorbital optic nerve sheath following severe head trauma in an adult is reported. A young man was admitted to the emergency department following a high-speed motorcycle accident with unconsciousness, forehead laceration, and multiple fractures of the skull and extremities. On admission, the pupils were dilated and fixed. Computed tomography revealed right subdural hematoma with midline shift, brain stem hemorrhage, contusion of the left temporal lobe, multiple facial bone fractures, cerebral edema with intracerebral air, and meningeal pneumatization of the optic nerve sheaths bilaterally. This case demonstrates that after severe head trauma, air may extend in the optic nerve sheath, which could be a marker of severe optic nerve injury.
