117,377 research outputs found
Intervertebral disc calcification in childhood: Case report and review of relevant literature
No full textThe authors report the case of a 10-year-old girl with intervertebral disc calcifications from the levels C6/C7 to Th1/Th2, presenting with a herniated calcified intervertebral disc at the C7/Th1 level, causing spinal cord compression with subsequent progressive paresis and sensory loss of her left leg. After anterior cervical discectomy and fusion the neurological deficits completely resolved within 2 weeks. It can be concluded that calcification of an intervertebral disc is a rare syndrome in childhood, causing progressive neurological deficit only in a few reported cases. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurological deficit
Ruptured Tentorial Arteriovenous Fistula: Endoscopic-Assisted Microsurgical Disconnection Using Indocyanine Green Videoangiography Guidance
No full textTentorial dural arteriovenous fistulas are rare causes of intracranial hemorrhage and nervous tissue venous congestion. Due to their extensive arterial supply and difficult transvenous endovascular navigation, they are frequently managed microsurgically. Precise identification of the venous drainage, its retractorless exposition, and real-time verification of arteriovenous disconnection are the mainstays of surgery. We describe the case of 61-year-old man presenting with a cerebellar hematoma causing obstructive hydrocephalus, resolved by emergent endoscopic third ventriculocisternostomy, with no need of external ventricular drain.1 Brain angiograms showed a straight sinus dural arteriovenous fistula. The fistulous point could not be reached endovascularly due to the small caliber and tortuosity of the arterial feeders and difficult transvenous navigation, and then the endovascular treatment was limited to closure of both occipital arteries. At surgery, indocyanine green videoangiography with semiquantitative assessment of flow dynamics identified the draining vein originating from the dura of the left wall of the straight sinus (Video 1). After the draining vein was clipped at its origin from the straight sinus and the endoscopic view confirmed that the clip's tips straddled the vein, control indocyanine green videoangiography showed no more early injection of the draining vein and restoration of the normal venous drainage. Postoperative angiograms confirmed the elimination of the fistula. The patient was discharged to a rehabilitation facility 5 days postoperatively and regained functional independence, with a modified Rankin Scale score of zero by the third month after surgery. Relevant teaching points are exposed at the end of the case narration
Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter?
No full textBackground Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant
to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear.
Methods Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic
stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA).
Results All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of
the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a
small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or
strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH.
None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition,
DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection.
Conclusions We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic
hypothesis of coexisting c-SAH and AIS
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