RESUMO
A sacral dural arteriovenous fistula (dAVF) is extremely rare, and the pathophysiological and clinical features have not been established. A 70-year-old man developed gradually progressive right-dominant bilateral sensory disorder of the lower limbs. His clinical course and electrophysiological findings were similar to those of multiple mononeuropathy. However, angiography showed a sacral dAVF at the right intervertebral foramen between the fifth lumbar and first sacral vertebrae. Endovascular embolization of the dAVF improved his clinical symptoms and electrophysiological findings. A sacral dAVF can mimic multiple mononeuropathy in terms of its clinical features and electrophysiological findings. A sacral dAVF is a treatable disease and should be considered as a differential diagnosis of lower extremity disorders.
Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Mononeuropatias/diagnóstico por imagem , Condução Nervosa/fisiologia , Sacro/diagnóstico por imagem , Idoso , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Potenciais Somatossensoriais Evocados/fisiologia , Seguimentos , Humanos , Masculino , Mononeuropatias/fisiopatologia , Mononeuropatias/terapiaRESUMO
Afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy (PD) can be managed by either surgical or nonsurgical treatment. The general condition of patients with recurrent pancreaticobiliary cancer is often not good enough for them to undergo surgery, so less invasive nonsurgical treatment is desirable. We report a case of a 66-year-old male who had undergone PD for pancreatic head adenocarcinoma 10 months previously and who presented at our hospital with fever and jaundice due to afferent loop obstruction caused by pancreatic cancer recurrence. An endoscopic self-expandable metal stent (SEMS) was placed for afferent loop obstruction without any complications. He quickly recovered after SEMS placement. He retained a good quality of life by receiving chemotherapy until his death due to cancer progression. Our case indicates that this method could be an easy, effective, safe, and less invasive treatment, which may confer a better quality of life for patients with afferent loop obstruction due to cancer recurrence after PD.
Assuntos
Adenocarcinoma/complicações , Endoscopia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Recidiva Local de Neoplasia/complicações , Neoplasias Pancreáticas/complicações , Stents Metálicos Autoexpansíveis , Adenocarcinoma/cirurgia , Idoso , Humanos , Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Masculino , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Qualidade de Vida , Neoplasias PancreáticasRESUMO
Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that is frequently accompanied by systemic complications. Neuropathologies have not been well investigated as extraintestinal manifestations of CD. We herein report the case of a 36-year-old man with CD who presented with progressive weakness and numbness. A neurological examination and the results of a nerve conduction study and a sural nerve biopsy led to a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Plasma exchanges were initially effective; however, the effects gradually declined starting 10 days after the plasma exchange (PE). These results suggest that humoral factors may play an important role in CIDP associated with CD.
