RESUMO
BACKGROUND: Cerebral fat embolism syndrome is a rare, but potentially lethal, complication of long bone fractures. Neurological symptoms are variable, and the clinical diagnosis is difficult. The purpose of this case study is to demonstrate the value of diffusion-weighted MRI of the brain for early diagnosis of fat embolism syndrome. Case Description- A non-head-injured 18-year-old woman suffered acute mental status changes 21 hours after an uncomplicated fracture of the left tibia. MRI of the brain was performed 48 hours after injury. T2-weighted images showed multiple nonconfluent areas of high signal intensity, which, on the diffusion-weighted scans, were revealed as bright spots on a dark background ("starfield" pattern). We suggest that this indicates areas of restricted diffusion that are due to cytotoxic edema, resulting from multiple microemboli. CONCLUSIONS: High-intensity lesions in the brain on diffusion-weighted images may serve as an early-appearing and more sensitive indicator of the diagnosis of fat embolism in the clinical context of long bone injury without head trauma.
Assuntos
Embolia Gordurosa/diagnóstico , Embolia Intracraniana/diagnóstico , Imageamento por Ressonância Magnética , Fraturas da Tíbia/complicações , Acidentes de Trânsito , Adolescente , Encéfalo/patologia , Embolia Gordurosa/etiologia , Exantema/diagnóstico , Exantema/etiologia , Feminino , Escala de Coma de Glasgow , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Embolia Intracraniana/etiologia , Imageamento por Ressonância Magnética/métodos , Valor Preditivo dos Testes , SíndromeRESUMO
In a series of 6 severely head injured patients, intraventricular as well as rectal, bladder and jugular vein temperature is recorded. The relationship between these temperatures in different conditions is evaluated. Intracerebral temperature is 0.5 +/- 0.2 degrees C (mean +/- SD) higher than bladder temperature except in conditions such as brain death. It is concluded that rectal temperature is not representative and therefore not a good alternative to the measurement of brain temperature. More data on human intracerebral temperature are mandatory as well as prospective studies correlating intracerebral temperature with final outcome in head injury.
Assuntos
Regulação da Temperatura Corporal/fisiologia , Traumatismos Cranianos Fechados/fisiopatologia , Monitorização Fisiológica/instrumentação , Termômetros , Adulto , Idoso , Ventrículos Cerebrais/fisiopatologia , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Bilateral obturator hernias were diagnosed in a 61-year-old woman by CT-scan examination, permitting an elective surgical repair by preperitoneal interposition of Teflon mesh. The condition developed in a patient presenting with a 15-year history of chylous ascites, occasioned by primary hypoplasia of the lymphatic system and cirrhosis of the liver.
Assuntos
Ascite Quilosa/complicações , Hérnia do Obturador/diagnóstico por imagem , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/cirurgia , Humanos , Pessoa de Meia-Idade , Politetrafluoretileno , Próteses e Implantes , Telas Cirúrgicas , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
From 1983 to 1989, 120 injections of glycerol into the trigeminal ganglion were performed to treat facialgias of different origin. The subjective and objective consequences and complications are reviewed. Since this operation yielded most often mild, transient and well tolerated consequences and complications for the patient, we now propose this method as first choice for trigeminal neuralgia when there is no anamnestic or clinical evidence of damage to the trigeminal system.
