Placenta percreta con invasión vesical: una causa infrecuente de hematuria en la embarazada / Placenta percreta with bladder invasion: an uncommon cause of hematuria during pregnancy

La placenta percreta con invasión de la vejiga es una entidad muy infrecuente que puede producir complicaciones muy graves para la embarazada. Aunque a menudo se diagnostica en el momento del parto, las técnicas de imagen son muy útiles para diagnosticarla precozmente, lo que resulta fundamental para la planificación quirúrgica y evitar complicaciones potencialmente mortales. Presentamos un caso de esta entidad, y realizamos un breve repaso bibliográfico, con énfasis en el papel de las técnicas de imagen. Se trata de una gestante con antecedente de cesárea previa, hematuria y dolor lumbar. Tras realizar una ecografía y una resonancia magnética, se sugirió el diagnóstico de placenta percreta con invasión vesical, que se confirmó quirúrgicamente (AU)

Placenta percreta with bladder invasion is a very uncommon condition that can lead to very severe complications in pregnant women. Although it is often diagnosed during delivery, imaging techniques are very useful for early diagnosis, which is fundamental for planning surgery and avoiding potentially lethal complications. We present the case of a woman with a history of cesarean section who presented with hematuria and low back pain. The diagnosis of placenta percreta with bladder invasion was suggested after ultrasonography and magnetic resonance imaging and was confirmed at surgery. We provide a brief review of the literature, emphasizing the role of imaging techniques (AU)

[Placenta percreta with bladder invasion: an uncommon cause of hematuria during pregnancy]. / Placenta percreta con invasión vesical: una causa infrecuente de hematuria en la embarazada.

Placenta percreta with bladder invasion is a very uncommon condition that can lead to very severe complications in pregnant women. Although it is often diagnosed during delivery, imaging techniques are very useful for early diagnosis, which is fundamental for planning surgery and avoiding potentially lethal complications. We present the case of a woman with a history of cesarean section who presented with hematuria and low back pain. The diagnosis of placenta percreta with bladder invasion was suggested after ultrasonography and magnetic resonance imaging and was confirmed at surgery. We provide a brief review of the literature, emphasizing the role of imaging techniques.

Síndrome de hipotensión intracraneal: revisión de hallazgos en resonancia magnética / Intracranial hypotension syndrome: a review of the magnetic resonance findings

Introducción. El síndrome de hipotensión intracraneal (SHI) es un síndrome de etiología y presentación clínica variable, causada, en la mayoría de casos, por fuga de líquido cefalorraquídeo a través del saco tecal. La cefalea ortostática asociada a los hallazgos típicos en resonancia magnética (RM), secundarios a la depleción del líquido cefalorraquídeo, constituye a clave para el diagnóstico. Objetivo. Mostrar los hallazgos radiológicos que en un contexto clínico adecuado permiten identificar y diagnosticar esta entidad. Desarrollo. La disminución del volumen del líquido cefalorraquídeo desempeña un papel importante en el SHI, que lleva a un aumento del volumen de sangre compensatorio, fundamentalmente dependiente del sistema venoso. La RM es una técnica sensible en el diagnóstico del SHI. No obstante, los hallazgos por separado son inespecíficos. Entre los hallazgos en RM se encuentran el realce dural difuso y homogéneo, la presencia de pequeñas colecciones subdurales bilaterales, desplazamiento caudal de las estructuras encefálicas (pseudo-Chiari), dilatación de venas corticales y medulares, y el reciente signo de la distensión venosa. Este último signo constituye un hallazgo altamente sensible de SHI, que tiende adesaparecer tras la mejoría clínica del paciente incluso antes de la desaparición del realce paquimeníngeo, y que podría utilizarse como marcador de respuesta al tratamiento. Conclusión. El SHI es una entidad de difícil diagnóstico clínico en la que se han descrito hallazgos típicos en la RM con los que el neurólogo y el radiólogo deben estar familiarizados (AU)

Introduction. Intracranial hypotension syndrome (IHS) is a syndrome with a variable aetiology and clinical presentation that is, in most cases, caused by leakage of cerebrospinal fluid (CSF) through the thecal sac. Orthostatic headache associated to the typical magnetic resonance imaging (MRI) findings, secondary to depletion of CSF, is the key to a correct diagnosis. Aims. To show the imaging findings that, within a suitable clinical context, allow this condition to be identified and diagnosed. Development. Decreased CSF volume plays an important role in IHS, which leads to an increase in the compensatory volume of blood, essentially dependent on the venous system. MRI is a sensitive technique in the diagnosis of IHS. Yet, separate findings are unspecific. The MRI findings include diffuse and homogeneous dural enhancement, the presence of small bilateral subdural collections, caudal displacement of the encephalic structures (pseudo-Chiari), dilatation of thecortical and medullar veins, and the recent sign of venous distension. This last sign is a highly sensitive finding of IHS, which tends to disappear following the patient’s clinical improvement even before the disappearance of the pachymeningeal enhancement, and could be used as a marker for response to treatment. Conclusions. IHS is a condition that is difficult to diagnose clinically for which several typical MRI findings have been reported; both neurologists and radiologists must be familiar with these findings (AU)

Anatomy of the brainstem: a gaze into the stem of life.

The brainstem has an ectodermal origin and is composed of 4 parts: the diencephalon, mesencephalon, pons, and medulla oblongata. It serves as the connection between the cerebral hemispheres with the medulla and the cerebellum and is responsible for basic vital functions, such as breathing, heartbeat blood pressure, control of consciousness, and sleep. The brainstem contains both white and gray matter. The gray matter of the brainstem (neuronal cell bodies) is found in clumps and clusters throughout the brainstem to form the cranial nerve nuclei, the reticular formation, and pontine nuclei. The white matter consists of fiber tracts (axons of neuronal cells) passing down from the cerebral cortex--important for voluntary motor function--and up from peripheral nerves and the spinal cord--where somatosensory pathways travel--to the highest parts of the brain. The internal structure of brainstem, although complex, presents a systematical arrangement and is organized in 3 laminae (tectum, tegmentum, and basis), which extend its entire length. The motor pathway runs down through the basis, which is located at the most anterior part. The cranial nerve nuclei are settled into the middle layer (the tegmentum), just in front of the 4th ventricle and are placed, from medial to lateral, on the basis of their function: somatic motor, visceral motor, visceral sensory, and somatic sensory. All the somatosensory tracts run upward to the thalamus crossing the tegmentum in front of the cranial nerve nuclei. The tectum, formed by the quadrigeminal plate and the medullary velum, contains no cranial nuclei, no tracts and no reticular formation. The knowledge of precise anatomical localization of a lesion affecting the brainstem is crucial in neurological diagnosis and, on this basis, is essential to be familiar with the location of the mayor tracts and nuclei appropriately. Nowadays, current magnetic resonance imaging techniques, although still macroscopic, allow the fine internal structure of the brainstem to be viewed directly and make it possible to locate the main intrinsic structures that justify the symptoms of the patient. In this article we discuss the anatomy of the brainstem and highlight the features and landmarks that are important in interpreting magnetic resonance imaging.