RESUMO
We report an unusual case of intradural intraradicular lumbar disc herniation, in which an extruded fragment of disc was found within the sheath of the left S1 nerve root. Previous surgery of our patient in another medical centre was not beneficial. The diagnosis of intraradicular extruded disc herniation was made at the time of surgery during exploration of the L5-S1 disc space. Although magnetic resonance imaging is a useful diagnostic tool in all patients with lumbar disc herniation, preoperative correct diagnosis is usually difficult, as occurred in our patient. A careful observation of the root during surgery is indicated to detect such an anatomical abnormality, especially in cases with recurrent disc herniation.
Assuntos
Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Compressão da Medula Espinal/cirurgia , Adulto , Diagnóstico Diferencial , Dura-Máter/patologia , Dura-Máter/cirurgia , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Laminectomia/efeitos adversos , Vértebras Lombares/patologia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: Involvement of the brain by Aspergillus fumigatus, named as invasive aspergillosis, is extremely rare. Definitive diagnosis needs isolation of the fungus from the tissue specimens and its culture. The disease is very resistant to treatment and quickly becomes fatal despite antifungal chemotherapy with AmB preparations, the drugs of choice for the infection. CASE DESCRIPTION: We hereby present a unique case of fungal granuloma of the brain due to A fumigatus, which was cured successfully by intensive antifungal treatment, along with a brief literature review. CONCLUSIONS: Although it is rare, we draw the attention to the fact that early diagnostic procedures with rapid confirmation of Aspergillus infection and an early initiation of therapy are pivotal for a benign clinical course in such cases. A complete regression of the disease could be achieved with medical therapy alone with conventional AmB or liposomal AmB combined with oral itraconazole even if a total surgical excision of the lesions could not be performed in complicated cases, as in our patient.
