RESUMO
No disponible
No disponible
Assuntos
Humanos , Masculino , Idoso , Acidente Vascular Cerebral/cirurgia , Revascularização Cerebral/métodos , StentsRESUMO
No disponible
Assuntos
Humanos , Doença de Moyamoya/diagnóstico , Ética em Pesquisa , Pesquisa Biomédica/métodosRESUMO
PATIENTS AND METHODS: A total of 12 patients with moyamoya disease or syndrome with a mean age of 6 years were analyzed in a retrospective fashion. RESULTS: Infarction was the most frequent presentation feature (8 out of 12 patients), 2 had epilepsy and 2 were incidental findings. Seven cases were classified as idiopathic while the other five were related to systemic illnesses. Diagnosis was initially made by magnetic resonance angiography in 9 cases, and conventional angiography in 3 cases. Mean follow-up is 5 years; six patients experienced clinical worsening of symptoms, while 6 cases remained clinically stable. However, all of them showed angiographic progression. Four patients underwent revascularization surgery. Two children died due to complications associated with moyamoya disease, and six have moderate handicaps. CONCLUSION: Due to the fact moyamoya disease is not an indolent disorder and readily progress to cause complications, surgical revascularization should always be considered in the management of these patients.
Assuntos
Doença de Moyamoya/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos RetrospectivosRESUMO
Pacientes y métodos. Estudio descriptivo, longitudinal, de 12 niños no asiáticos con síndrome o enfermedad de moyamoya, con el objetivo de analizar su presentación y evolución clinicorradiológica. Resultados. La edad promedio de inicio fue de 6 años; ocho se iniciaron con infarto cerebral, dos con epilepsia y dos fueron hallazgo casual. Siete se consideraron idiopáticos(enfermedad de moyamoya) y cinco asociados a enfermedades sistémicas (síndrome de moyamoya). El diagnóstico inicial se confirmó por angiorresonancia en nueve casos y en tres por arteriografía convencional. El seguimiento promedio fue de 5 años; seis evidenciaron progresividad clínica y seis estabilidad clínica. Todos tuvieron progresividad angiográfica. En cuatroniños se realizaron siete cirugías de revascularización. Dos niños fallecieron, uno por hemorragia cerebral y otro por un infarto cerebral expansivo, mientras que seis pacientes presentaron secuelas leves a moderadas. Conclusión. Es importante identificara los niños afectados por esta patología, ya que se pueden beneficiar de cirugía de revascularización, una de las pocas opciones terapéuticas para evitar la progresión y complicaciones de esta grave enfermedad
A total of 12 patients with moyamoya disease or syndrome with a mean age of 6 years wereanalyzed in a retrospective fashion. Results. Infarction was the most frequent presentation feature (8 out of 12 patients), 2 had epilepsy and 2 were incidental findings. Seven cases were classified as idiopathic while the other five were related to systemicillnesses. Diagnosis was initially made by magnetic resonance angiography in 9 cases, and conventional angiography in 3 cases. Mean follow-up is 5 years; six patients experienced clinical worsening of symptoms, while 6 cases remained clinicallystable. However, all of them showed angiographic progression. Four patients underwent revascularization surgery. Two children died due to complications associated with moyamoya disease, and six have moderate handicaps. Conclusion. Due to the fact moyamoya disease is not an indolent disorder and readily progress to cause complications, surgical revascularizationshould always be considered in the management of these patients
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Doença de Moyamoya/epidemiologia , Doença de Moyamoya/cirurgia , Revascularização Cerebral , Isquemia Encefálica/cirurgia , Diagnóstico PrecoceRESUMO
INTRODUCTION: Dissection of vertebral artery is an unusual pathology but sometimes is the cause of stroke in young patients. Since last years, and with the rise of some chiropractic technics, some authors have related these ones with the dissection of vertebral artery. CASE REPORT: We show a case of a 37 years old woman that after a chiropractic session began symptoms of posterior circulation dysfunction as decrease level of sense, tetraparesis and alteration of cranial nerves. The arteriography confirmed the existence of a vertebral dissection of V2 portion and thrombosis of basilar and contralateral vertebral arteries. Intraarterial fibrinolysis was performed with complete recanalization of the artery. Although this, the patient had parenchimal lesions in pons, cerebellum and territory of posterior cerebral artery that produced a locked-in syndrome. All the complementary exams were normal. DISCUSSION: We discuss the relationship between cervical manipulation as an aetiology of vertebral dissection, locked-in syndrome and therapeutic options in these patients
Assuntos
Fibrinólise , Manipulação Quiroprática/efeitos adversos , Quadriplegia/etiologia , Dissecação da Artéria Vertebral , Adulto , Isquemia Encefálica/etiologia , Isquemia Encefálica/patologia , Vértebras Cervicais , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Quadriplegia/patologia , Síndrome , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/tratamento farmacológico , Dissecação da Artéria Vertebral/etiologia , Dissecação da Artéria Vertebral/patologia , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/patologiaRESUMO
Introducción. La disección de la arteria vertebral es una patología poco frecuente, pero que en ocasiones se ha implicado en la etiología del ictus en pacientes jóvenes. Desde hace algunos años, se han relacionado determinadas técnicas quiroprácticas, que poseen un elevado grado de aceptación, con la aparición de este fenómeno. Caso clínico. Presentamos el caso de una paciente de 37 años que, después de una sesión de masaje cervical, presentó una clínica progresiva de disminución del nivel de conciencia, tetraparesia y alteración de los pares craneales compatible con trastornos de la circulación posterior. Una arteriografía confirmó la sospecha de la existencia de una disección de la arteria vertebral izquierda, segmento V2, con una trombosis basilar y vertebral contralateral secundarias. Se realizó una fibrinólisis intrarterial y se consiguió la lisis del trombo y la recanalización arterial. A pesar de ello, la paciente presentó múltiples lesiones parenquimatosas en el tronco, el cerebelo y el territorio de la arteria cerebral posterior, que configuraron un síndrome clínico de enclaustramiento. El estudio etiológico mostró una absoluta normalidad de todas las exploraciones practicadas. Discusión. Se discuten las posibles relaciones de la manipulación cervical como causa de disección vertebral, su implicación etiológica con el síndrome de enclaustramiento y las opciones terapéuticas en estos pacientes (AU)
Introduction. Dissection of vertebral artery is an unusual pathology but sometimes is the cause of stroke in young patients. Since last years, and with the rise of some chiropractic technics, some authors have related these ones with the dissection of vertebral artery. Case report. We show a case of a 37 years old woman that after a chiropractic session began symptoms of posterior circulation dysfunction as decrease level of sense, tetraparesis and alteration of cranial nerves. The arteriography confirmed the existence of a vertebral dissection of V2 portion and thrombosis of basilar and contralateral vertebral arteries. Intraarterial fibrinolysis was performed with complete recanalization of the artery. Although this, the patient had parenchimal lesions in pons, cerebellum and territory of posterior cerebral artery that produced a locked-in syndrome. All the complementary exams were normal. Discussion. We discuse the relationship between cervical manipulation as an aetiology of vertebral dissection, locked-in syndrome and therapeutic options in these patients (AU)
Assuntos
Humanos , Feminino , Adulto , Dissecação da Artéria Vertebral , Fibrinólise , Quadriplegia , Vértebras Cervicais , Insuficiência Vertebrobasilar , Síndrome , Manipulação Quiroprática , Fibrinolíticos , Isquemia EncefálicaRESUMO
PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating spinal metastases that result in pain or instability. MATERIALS AND METHODS: Thirty-seven patients (20 men, 17 women; aged 33-86 years) underwent 52 percutaneous injections of surgical cement into a vertebra (vertebroplasty) with fluoroscopic guidance in 40 procedures. Vertebroplasty was performed for analgesia in 29 procedures, stabilization of the vertebral column in five procedures, and both in six procedures. RESULTS: Twenty-four of the 33 procedures performed for analgesia that were evaluated resulted in clear improvement; seven, moderate improvement; and two, no improvement. Improvement was stable in 73% of patients at 6 months. In the procedure performed for stabilization, no displacement of treated vertebrae was observed (mean follow-up, 13 months). Three patients had transient radiculopathy due to cement extrusion, and two patients had transient difficulty in swallowing. CONCLUSION: Vertebroplasty of metastases is a minimally invasive procedure that provides immediate and long-term pain relief and contributes to spinal stabilization.
