RESUMO
BACKGROUND: We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress. This is of interest as the patient had no other symptomatology, especially given the size of the mass, which would typically cause a pressure effect leading to neurological and auditory symptoms. CASE SUMMARY: This case report described a 48-year-old male who was married with two children and employed as a car guard. He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler. He initially presented to our facility with severe respiratory distress. He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator. He had no constitutional symptoms or impairment of hearing. On clinical examination, the patient's chest was "silent." Our initial assessment was status asthmaticus with type 2 respiratory failure, based on the history of asthma, a "silent chest," and the arterial blood gas results. CONCLUSION: A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy. The patient's chief presenting feature was severe respiratory distress, which combined with his background medical history of asthma, was misleading. Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.
RESUMO
Background: Incidentally detected unruptured intracranial aneurysms have a prevalence of 3% with some predisposed to rupture and others remaining static. Diagnostic knowledge of previous aneurysmal subarachnoid haemorrhage (ASAH) in the chronic phase could identify patients requiring treatment. Objectives: To assess the sensitivity of susceptibility weighted imaging (SWI) in the detection of ASAH at 3 months post ictus and determine any influencing effects. Method: A retrospective chart analysis of 46 patients with ASAH who underwent post-embolisation SWI imaging at 3 months. The SWI and available initial CT brain scans or CT reports were evaluated and correlated with patient demographics and clinical severity. Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASAH at 3 months. Increased number of haemosiderin zones on SWI correlated with older patient age (p = 0.0003). Clinical severity (World Federation Neurosurgical Societies Score) showed a tendency towards a statistically relevant relationship (p = 0.07). No statistically significant relationship was identified between the number of haemosiderin zones and initial CT modified Fisher score (p = 0.34) or the causative aneurysm location (p = 0.37). Conclusion: Susceptibility weighted imaging is sensitive in the detection of ASAH at 3 months, increasing in sensitivity with patient age and higher initial clinical severity. Contribution: In patients presenting in the subacute to chronic phase with a clinically suspicious history of previous aneurysm rupture but without convincing CT or spectrophotometry evidence, SWI can detect previous rupture. This can identify patients who could benefit from endovascular treatment and those who can safely undergo follow-up imaging.
