RESUMO
We present a case of Brown-Séquard syndrome (BSS) after thoracic endovascular aortic repair (TEVAR) to treat Stanford type B aortic dissection. A 49-year-old male presented to the emergency department with acute tearing pain between the scapulae, connected to respiratory movements. Computed tomography showed Stanford type B aortic dissection from the left subclavian artery to the level of the 11th thoracic vertebra. Conservative treatment was initiated with intravenous antihypertensives. However, due to persistent pain and an increase in the aortic diameter with an intramural hematoma, TEVAR was performed. The patient developed symptoms suspicious of spinal cord ischemia postoperatively. A lesion limited to the left-sided spinal cord was observed on magnetic resonance imaging at the level of the 4th to 5th thoracic vertebra. BSS after TEVAR is a rare phenomenon with a fairly good prognosis, depending on the initial injury severity.
RESUMO
BACKGROUND Tick-borne relapsing fever is a disease that is caused by infection with a Borrelia bacterium, and is transmitted by ticks. This infectious disease is characterised by relapsing episodes of high fever, often accompanied by aspecific symptoms. CASE DESCRIPTION We describe the history of a 20-year-old woman who developed recurrent episodes of fever with headache and vomiting after a holiday in Morocco. Additional examination showed pleiocytosis in the cerebrospinal fluid, which was initially suggestive of viral meningitis. However, Borrelia spp. were isolated from a 16S-rRNA-PCR-test which led to the diagnosis 'tick-borne relapsing fever'. The patient was treated with intravenous ceftriaxone for two weeks, after which time her symptoms gradually improved. CONCLUSION Prompt antibiotic treatment of tick-borne relapsing fever can prevent a serious course of the disease. For this reason, in patients with recurrent episodes of fever, it is important to consider this diagnosis if they have recently made a trip to Africa, America or the Middle East.