RESUMO
PURPOSE: The aim of this study was to show the different origins and courses of the extracranial VA on CTA with special emphasis on embryological considerations. The duplicated VA is an anomaly that has been assumed to predispose for dissection and to be associated with aneurysms. We report its frequency and clinical significance. METHODS: We retrospectively reviewed CTA of 539 patients by using a contrast-enhanced CTA protocol of the VA on CT. RESULTS: Ninety-four-point-two percent of left VA originated from left subclavian artery and entered the transverse foramen at C6 in nearly all cases. Six-point-three-percent of left VA (m = 4 %, f = 10 %) originated from the aortic arch and entered the transverse foramen either at C4, C5 or C7 but never at C6. One case of an aberrant retroesophageal right VA originated from the aortic arch distal to the left subclavian artery and entered at C7 (0.19 %). All other right VA originated from the right subclavian artery (99.8 %) and entered between C4 and C6. We diagnosed four cases of duplicated VA (0.74 %) with a female predominance (1.9 %) without any signs of dissection on CTA. Two cases with VA duplication had intracranial arterial aneurysms. CONCLUSIONS: The VA is a longitudinal anastomosis of segmental metameric arteries. The level of entrance into the transverse foramen indicates which metameric artery or arteries persist. Duplication corresponds to persistence of two segmental arteries and is a rare phenomenon. VA duplication might be associated with vascular lesions.
Assuntos
Angiografia Cerebral , Tomografia Computadorizada Multidetectores , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/embriologia , Adulto , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Aneurisma/embriologia , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/embriologia , Meios de Contraste , Feminino , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/embriologia , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/embriologia , Artéria Vertebral/anormalidades , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/embriologiaRESUMO
As a result of continuing progress in the development of intervention materials but also due to growing understanding of pathophysiological relationships, the prevalence and significance of endovascular interventions in the head and neck region have continued to increase. This applies to procedures for recanalization, which were addressed in detail in an earlier article, as well as to techniques used for vessel occlusion. This contribution first presents the techniques and materials employed in embolization in the head and neck region. Based on this description the application of endovascular procedures for vessel occlusion are explained with respect to different disease entities in the head and neck region. In this context particular attention is given to the treatment of intracranial aneurysms, cerebral arteriovenous malformations, dural AV fistulae, vascular malformations, and tumors in the head and neck region.
Assuntos
Arteriopatias Oclusivas/cirurgia , Prótese Vascular , Cabeça/irrigação sanguínea , Pescoço/irrigação sanguínea , Stents , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/métodos , Cabeça/cirurgia , Humanos , Pescoço/cirurgiaRESUMO
Vascular interventions in the head and neck region are becoming increasingly more important due to acquisition of knowledge on the pathophysiological principles of various vascular diseases and the development of new intervention materials. This article gives a review of the materials and techniques used in interventions in the head and neck region. Special attention is given to the description of a safety-oriented approach to avoid potentially severe complications. Based on this the value of endovascular therapeutic procedures for recanalization of various diseases will be discussed, in particular the treatment of extracranial and intracranial stenoses and the reopening of vascular occlusions in acute stroke using PTA, stents, lysis and mechanical thrombus removal.
Assuntos
Estenose das Carótidas/terapia , Cateterismo/métodos , Angiografia Cerebral , Infarto Cerebral/terapia , Embolia Intracraniana/terapia , Stents , Trombectomia/métodos , Terapia Trombolítica/métodos , Insuficiência Vertebrobasilar/terapia , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/terapia , Estenose das Carótidas/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Comportamento Cooperativo , Humanos , Comunicação Interdisciplinar , Embolia Intracraniana/diagnóstico por imagem , Equipe de Assistência ao Paciente , Insuficiência Vertebrobasilar/diagnóstico por imagemAssuntos
Artéria Basilar/anormalidades , Artéria Carótida Interna/anormalidades , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Cerebelo/irrigação sanguínea , Aneurisma Intracraniano/diagnóstico , Artéria Vertebral/anormalidades , Adulto , Malformações Vasculares do Sistema Nervoso Central/terapia , Angiografia Cerebral , Embolização Terapêutica , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Aneurisma Intracraniano/terapia , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/terapia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Intracranial hypotension is a frequently misdiagnosed syndrome which is caused by reduced intracranial cerebrospinal fluid (CSF) pressure due to spontaneous spinal CSF leakage. We present our series of intracranial hypotension regarding especially the required diagnostic imaging and the treatment. METHODS: A retrospective analysis was performed on 8 patients (5 males, 3 females, mean age 49 years) with postural and non-postural headache due to spinal CSF collection. RESULTS: Cranial MRI showed diffuse pachymeningeal gadolinium enhancement in all cases. CSF leakage detected by gadolinium-enhanced MR cisternography could be either diffuse (n=5) or precisely located around a dural tear (n=3). All but one leakages were located at the thoracic spine. In 6 patients 40-65 mL of blood were injected through epidurally placed drainages. In 1 patient, a dural tear was sealed with fibrin glue and fat. One patient refused surgical intervention. One epidural haematoma had to be revised. 5 of 7 patients showed excellent results. CONCLUSION: Gadolinium-enhanced MR cisternography best revealed CSF leaks. In the majority of patients with spontaneous intracranial hypotension, complete recovery may be achieved via a midthoracic epidural blood patch with minimal complications.
Assuntos
Hipotensão Intracraniana/etiologia , Hipotensão Intracraniana/cirurgia , Derrame Subdural/etiologia , Derrame Subdural/cirurgia , Adulto , Placa de Sangue Epidural , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Dura-Máter/lesões , Dura-Máter/cirurgia , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Gadolínio DTPA , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Injeções Espinhais , Hipotensão Intracraniana/diagnóstico , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Exame Neurológico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Derrame Subdural/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Although digital subtraction angiography (DAS) remains the gold standard for neurovascular imaging, the number of diagnoses made on the basis of less invasive cross-sectional imaging techniques (CT and MR angiography) is increasing. The present article provides important technical principles of CT and MR angiography, followed by an analysis of the diagnostic possibilities and limitations of vascular cross-sectional imaging. The particular importance of post-processing of vascular cross-sectional datasets is also discussed. Using the typical clinical diagnostic work-up of extra- and intracranial vascular diseases as a basis, the article explains how a suitable examination technique and protocol is chosen and which limitations need to be borne in mind. After taking at look at the technical advances expected in the future (3-Tesla MRA, dual-energy CTA, post-processing workflow in PACS), the remaining indications for diagnostic DSA will be presented and explained.
Assuntos
Anatomia Transversal/tendências , Angiografia/tendências , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Imageamento por Ressonância Magnética/tendências , Tomografia Computadorizada por Raios X/tendências , Cabeça/irrigação sanguínea , Cabeça/diagnóstico por imagem , Cabeça/patologia , Humanos , Pescoço/irrigação sanguínea , Pescoço/diagnóstico por imagem , Pescoço/patologiaRESUMO
High-grade gliomas in children are rare and the best treatment is undetermined. The German language group study HIT-GBM compares various induction protocols for subsequent patient cohorts. Currently, cisplatinum, etoposide, ifosfamide, and vincristine are given simultaneously with extended-field radiotherapy. Imaging is done 3 weeks after to define treatment response, followed by 6-weekly controls during consolidation with lomustine, vincristine, and prednisone. The authors report on 2 patients with incompletely resected glioblastoma multiforme in which response was lacking 3 weeks after radiochemotherapy but became evident 12 weeks later. This suggests that later time points are required to assess induction protocol response.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Tronco Encefálico/tratamento farmacológico , Neoplasias do Tronco Encefálico/radioterapia , Irradiação Craniana , Glioblastoma/tratamento farmacológico , Glioblastoma/radioterapia , Neoplasias Supratentoriais/tratamento farmacológico , Neoplasias Supratentoriais/radioterapia , Neoplasias do Tronco Encefálico/cirurgia , Criança , Cisplatino/administração & dosagem , Terapia Combinada , Craniotomia , Progressão da Doença , Etoposídeo/administração & dosagem , Evolução Fatal , Seguimentos , Glioblastoma/cirurgia , Humanos , Ifosfamida/administração & dosagem , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Neoplasias Supratentoriais/cirurgia , Fatores de Tempo , Resultado do Tratamento , Vincristina/administração & dosagemRESUMO
We decided to test to what extent dose reduction is possible in abdominal spiral computed tomography (CT) in young children without loss of anatomic diagnostic information. A retrospective study was performed of 30 abdominal CT examinations of children aged 3 months to 7 years. These were divided into two groups: group A with reduced radiation exposure (tube current 50 mA, CT dose index CTDIFDA < or =0.83 mGy) and group B with standard radiation exposure (tube current > or =100 mA, CTDIFDA > or =1.66 mGy). Image quality was assessed using a four-part scale ('excellent', 'good', 'sufficient', 'poor') on visual image impression and visibility of 32 anatomical details. Five experienced radiologists read the CT scans independently who were blinded to the examination parameters. Differences in ranked data were evaluated with Wilcoxon's rank sum test. No difference between groups A and B was observed in visual image impression. Detail visibility was significantly lower in group A, but the differences were limited to right upper quadrant structures (portal vein, common bile duct, pancreatic head, adrenals) and to arterial branches. Significant differences in visibility rated as 'poor' were only found for the hepatic, splenic and renal arteries; all other structures showed no difference between groups A and B. A protocol with reduced radiation exposure (50 mA, CTDIFDA < or =0.83 mGy) allowed the demonstration of most anatomic structures in abdominal spiral CT in young children. For the precise demonstration of small details (e.g. structures of the right upper quadrant), a protocol with standard radiation exposure (> or =100 mAs) was superior.
Assuntos
Tomografia Computadorizada por Raios X/métodos , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Doses de Radiação , Estudos RetrospectivosRESUMO
BACKGROUND AND PURPOSE: One application of functional MR imaging is to identify the primary sensorimotor cortex (M1 and S1) around the central sulcus before brain surgery. However, it has been shown that undesirable coactivation of nonprimary motor areas, such as the supplementary motor area and the premotor area, can interfere with the identification of the primary motor cortex, especially in patients with distorted anatomic landmarks. We therefore sought to design a simple functional MR imaging paradigm for selective activation of the primary sensorimotor cortex. METHODS: Different paradigms using finger tapping for motor activation were examined and compared with respect to the distribution of activated voxels in primary and nonprimary cortical areas. Studies were conducted in 14 healthy volunteers using a blood oxygen level-dependent multislice echo-planar imaging sequence. RESULTS: The most selective activation of the primary sensorimotor cortex was obtained with a paradigm combining right-sided finger tapping as the activation condition with left-sided finger tapping as the control condition. Analysis of the signal time course of primary and nonprimary areas revealed that the highly selective primary motor activation was due to it being restricted to contralateral finger movements, as opposed to the nonprimary motor areas, which were activated by ipsilateral, contralateral, and bilateral finger movements alike. CONCLUSION: When performing functional MR imaging to determine the location of the primary sensorimotor cortex, one should compare unilateral voluntary movements as the activation condition with contralateral movements as the control condition to accentuate activation of the primary motor area and to suppress undesirable coactivation of nonprimary motor areas.
Assuntos
Mapeamento Encefálico , Imageamento por Ressonância Magnética , Córtex Motor/fisiologia , Córtex Somatossensorial/fisiologia , Adulto , Artefatos , Dominância Cerebral/fisiologia , Feminino , Humanos , Masculino , Atividade Motora/fisiologia , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
The cerebral blood flow velocity (CBFV) in the basal arteries during a word-generation task was assessed by functional transcranial Doppler ultrasonography (fTCD) and by functional magnetic resonance imaging (fMRI). The study investigates how event-related CBFV modulations in the middle cerebral artery (MCA) relate to regional cerebral blood flow (rCBF) changes. Both fMRI and fTCD were used in 13 subjects (7 men, 6 women, aged 21 to 44 years). The maximum difference of relative CBFV changes between the left and right MCA during the word-generation task was used as the language laterality index (LIfTCD). For the fMRI examination during the nearly identical language task, the corresponding index was defined by LIfMRI = 100(N(L) - N(R))/(N(L) + N(R)), where N(L) and N(R) refer to the numbers of voxels activated in the left and right hemisphere, respectively. The evoked CBFV changes expressed by LIfTCD and the corresponding laterality index, LIfMRI, estimated by fMRI showed a close linear relation (regression analysis: r = 0.95, p < 0.0001). The results of this study demonstrate that language-related velocity changes in the MCAs relate to rCBF increases in a linear fashion. Since the laterality indices assessed by fMRI and fTCD are in such close agreement both techniques can therefore be used in a complementary way.
Assuntos
Córtex Cerebral/fisiologia , Lateralidade Funcional/fisiologia , Idioma , Imageamento por Ressonância Magnética , Ultrassonografia Doppler , Adulto , Córtex Cerebral/irrigação sanguínea , Córtex Cerebral/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , MasculinoRESUMO
In this article we describe clinical applications of functional MRI (fMRI) at 1.0 T. All experiments were performed on a commercially available 1.0-T system (Magnetom Impact Expert, Siemens AG, Erlangen, Germany) using a blood oxygen level-dependent (BOLD)-sensitive multi-slice EPI technique (TE 66 ms, 4 mm slice thickness, 210 mm field of view, 64 x 64 acquisition matrix). Different paradigms for localization of the motor cortex and for language lateralization were tested in healthy subjects and patients. Methodological considerations concerning the development of the paradigms are also described. In all healthy subjects, motor activation elicited BOLD signal changes in the sensorimotor cortex, permitting identification of primary motor and sensory cortical areas. Furthermore, focal activation of different cortical areas by a language task was possible in 6 of 10 subjects. Nineteen motor studies were performed in 18 patients with supratentorial lesions, in most cases prior to neurosurgical procedures. In 14 studies, fMRI results demonstrated the localization of the motor hand areas relative to the lesion. The results proved valuable for preoperative planning and contributed to therapeutical decisions. We conclude that functional MRI for clinically relevant applications, such as localization of motor and language function, is feasible even at a field strength of 1.0 T without dedicated equipment.
Assuntos
Idioma , Imageamento por Ressonância Magnética , Córtex Motor/anatomia & histologia , Desempenho Psicomotor/fisiologia , Fala/fisiologia , Adulto , Idoso , Astrocitoma/diagnóstico , Astrocitoma/fisiopatologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/fisiopatologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiologia , Toxoplasmose Cerebral/diagnóstico , Toxoplasmose Cerebral/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: Different coagulation disorders have been associated with cerebral venous thrombosis (CVT). Until now, fewer than 50 patients have been reported with CVT and the factor V Leiden (FVL) mutation. Although the prevalence of FVL-positive patients with CVT ranged from 10% to 25%, it was as low as 0.5% to 3% in the control groups. Most other studies had not systematically searched for concomitant risk factors or previous thromboembolic events. To better define the relevance of the FVL mutation in conjunction with additional risk factors in CVT, we conducted the present case-control study. METHODS: Fifty-five patients with CVT were compared with 272 healthy controls. A standardized interview regarding established risk factors for venous thrombosis and the patients' and their families' histories for thromboembolic events was performed. The presence of the FVL mutation was determined by polymerase chain reaction on DNA obtained from peripheral blood leukocytes. RESULTS: Of 55 patients, 8 (14.5%) were heterozygous for the FVL mutation compared with 17 of 272 controls (6.25%). The relative risk for the presence of FVL was 2.55 (95% confidence interval, 1.04 to 6.26; P=0.04). Additional risk factors for CVT were frequently found in both the presence and absence of FVL. Recurrence of venous thromboembolic events was more frequent in patients with the FVL mutation (5 of 8 patients, 62.5%) than in those without this anomaly (8 of 47 patients, 17%; P<0.005). CONCLUSIONS: Our study confirms the FVL mutation as the most relevant hereditary risk factor for CVT. Coexisting risk factors are usually involved in the initiation of CVT. Patients with the FVL mutation are at an increased risk for recurrent venous thrombosis.
Assuntos
Transtornos Cerebrovasculares/genética , Fator V/genética , Mutação/fisiologia , Trombose Venosa/genética , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Feminino , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Valores de Referência , Fatores de Risco , Tromboembolia/genéticaAssuntos
Processamento de Imagem Assistida por Computador/instrumentação , Imageamento por Ressonância Magnética/instrumentação , Síndromes de Compressão Nervosa/diagnóstico , Raízes Nervosas Espinhais/irrigação sanguínea , Nervo Trigêmeo/irrigação sanguínea , Neuralgia do Trigêmeo/diagnóstico , Diagnóstico Diferencial , Humanos , Síndromes de Compressão Nervosa/complicações , Sensibilidade e Especificidade , Raízes Nervosas Espinhais/patologia , Nervo Trigêmeo/patologia , Neuralgia do Trigêmeo/etiologiaRESUMO
It was the aim of this study to determine the influence of non-invasive magnetic stimulation on the performance of a visually induced reaction task. The experiment was performed in 8 healthy volunteers. After a visual stimulus subjects had to move their thumbs as soon as possible. The muscular reaction was recorded with surface EMG on both sides. After the visual go-signal a magnetic stimulus (Fig. 8 coil) was applied above the right or left motor cortex at varying time intervals (30 and 110 ms). The magnetic stimulus was randomly given or not. Short time intervals between visual and magnetic stimulus induced a shortening, long intervals induced a prolongation of the reaction time. The contralateral reaction time was always longer than the ipsilateral one. Compared with the reaction times without magnetic stimulation, the intraindividual standard deviation of the reaction times was markedly reduced by the application of the magnetic stimulation. This reduction was greater in ipsilateral than in contralateral recordings. The kind of the instruction had additional modifying effects.
Assuntos
Magnetismo , Córtex Motor/fisiologia , Tempo de Reação/fisiologia , Potenciais Evocados , Humanos , Movimento , Músculo Esquelético/fisiologia , Polegar/fisiologiaRESUMO
Somatosensory evoked potentials (SEPs) were elicited by magnetic stimulation of the tibial nerve, gastrocnemic muscle and by stimulation over the spinous processes of lumbar vertebra 5 (L 5), thoracic vertebra 9 (Th 9) and cervical vertebra 7 (C 7). The first SEP-positivity (P1-latency) was measured in a group of 20 controls and in another group of 18 patients with syringomyelia. The P1-latencies of the latter group following the stimulations over Th 9 and C 7 were significantly longer than those of the controls. Furthermore a correlation between electrophysiological findings and clinical data of the patients could be proven. Thus the method emerged as an appropriate tool for the investigation of the central part of the sensory system and for the diagnosis of spinal abnormalities.
Assuntos
Potenciais Somatossensoriais Evocados , Siringomielia/fisiopatologia , Adulto , Estimulação Elétrica , Feminino , Humanos , Imageamento por Ressonância Magnética , Magnetismo , Masculino , Pessoa de Meia-Idade , Tempo de Reação , Valores de Referência , Siringomielia/diagnósticoRESUMO
In order to determine the function of the autonomic nervous system in syringomyelia, the sympathetic skin response (SSR) was performed in 13 patients with syringomyelia and 20 healthy controls. SSR was recorded from both palms and soles. In patients with syringomyelia, we found absent responses, prolonged latencies and reduced amplitudes. SSRs could be recorded in 15 out of the examined 26 upper extremities. The latencies were prolonged in 12 of these cases. In the lower limbs, 11 SSRs could be obtained. In 4 of these cases the latencies were prolonged. The SSR latencies recorded from the palms and soles were both significantly prolonged (p < 0.05) and the amplitudes were reduced (p < 0.05) as compared to normal persons. Our data strongly suggest involvement of the autonomic nervous system in syringomyelia as assessed by the SSR response (in upper and lower extremities). In our patients, the extent of autonomic dysfunction was not related to the stage or the duration of disease.
Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Resposta Galvânica da Pele/fisiologia , Pele/inervação , Sistema Nervoso Simpático/fisiopatologia , Siringomielia/fisiopatologia , Adulto , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Feminino , Pé/inervação , Mãos/inervação , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação/fisiologia , Valores de Referência , Siringomielia/diagnósticoRESUMO
To determine a possible involvement of the autonomic nervous system in amyotrophic lateral sclerosis (ALS), measurement of the sympathetic skin response (SSR) was performed in 15 patients with definite ALS. Findings were compared with those in 20 normal controls. In ALS patients the mean SSR latencies recorded from the palms and soles were both significantly prolonged (p < 0.05) and the amplitudes were reduced as compared with normal persons. In 5 patients, SSR potentials were completely lacking in one or even more extremities. Our data strongly suggest subclinical involvement of the autonomic nervous system in ALS as assessed by the SSR response. In our patients the extent of autonomic dysfunction was not related to the stage or the duration of disease.
Assuntos
Esclerose Lateral Amiotrófica/complicações , Doenças do Sistema Nervoso Autônomo/complicações , Resposta Galvânica da Pele , Adulto , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Three-dimensional MR tomography was used to examine the relationship between symptoms of trigeminal neuralgia and neurovascular compression of the nerve in 18 patients. The intensity of neurovascular interaction was classified according to neuroradiological criteria. We found that a radiologically defined compression or dislocation of the nerve by an artery was always associated with symptoms of trigeminal neuralgia. A simple contact between vessel and nerve, however, was also observed on the asymptomatic sides of 10 out of 18 patients. In 6 of 18 patients, in contrast, trigeminal neuralgia was present in spite of the absence of neurovascular contact. In accordance with a cited study based on autopsy and intraoperative findings, our findings indicate that, in a certain proportion of cases, trigeminal neuralgia may be caused by neurovascular compression alone, whereas in other cases, other pathogenetic factors may be involved to a varying degree or be even exclusively responsible for the development of trigeminal neuralgia. The possible significance of the method for a preoperative estimation of the success of microvascular decompression of the trigeminal nerve is discussed.
Assuntos
Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/complicações , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/etiologia , Adulto , Idoso , Artérias Cerebrais/patologia , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico , Masculino , Pessoa de Meia-Idade , Nervo Trigêmeo/irrigação sanguínea , Nervo Trigêmeo/patologia , Neuralgia do Trigêmeo/cirurgiaRESUMO
We report the original case of a patient with acute myelogenous leukemia who presented with a painless, complete bilateral oculomotor palsy during induction chemotherapy. Headache, signs of meningeal irritation or further neurological symptoms were absent throughout the course of illness. The CT revealed a subarachnoid hemorrhage (SAH). Within a day of the onset of symptoms, the oculomotor palsy subsided completely with no residual damage. To our knowledge, this is the first described case of SAH in leukemia with complete bilateral oculomotor palsy being the only clinical symptom. Furthermore, the spontaneous remission of this pathological condition is an extremely rare event.
Assuntos
Leucemia Mieloide Aguda/complicações , Doenças do Nervo Oculomotor/tratamento farmacológico , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/fisiopatologia , Leucemia Mieloide Aguda/fisiopatologia , Leucemia Mieloide Aguda/terapia , Imageamento por Ressonância Magnética , Masculino , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/fisiopatologia , Hemorragia Subaracnóidea/complicações , Trombocitopenia/complicações , Trombocitopenia/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Preterm births continue to be the leading cause of perinatal mortality despite efforts to prevent preterm labor. Tocolytic therapy with beta-mimetic drugs was believed to be the solution for preterm labor, but the Canadian Preterm Labor Investigators Group recently reported that the use of ritodrine had no significant beneficial effect. Despite the various methods presently used for the management of preterm labor and prevention of premature delivery, the incidence of preterm birth remains unchanged. Health professionals must remain optimistic, however, and continue to investigate causes, whether they are social or medical, and to seek the unknown. Nursing personnel should play an important role in this area as health promoters and educators of patients. Nurses should also collaborate with other health professionals to determine effectiveness of therapy and the causes of preterm labor. For instance, this author is currently involved in a research project seeking barriers to prenatal care using a questionnaire and reviewing maternal records in order to determine length of labor and its relationship to subsequent preterm labors. The goals of the Year 2000 National Health Objective for low birth weight and infant mortality are not likely to be attained. Prematurity has gained national attention, however, and with public and professional awareness, perhaps this problem will decrease.