Biomedical subjects
Publications and source records attributed to A Isla.
We report a case of a patient with symptoms and signs of sciatica, due to spinal epidural abscess caused by Brucella, which was diagnosed by Magnetic Resonance Image. The literature is reviewed and the radiological features, particularly magnetic resonance image findings, are analyzed.
Two patients with epidural cavernous hemangiomas located at the lumbar and cervical spine are reported. The first case presented clinically as progressive paraparesis, and the second began with sudden tetraparesis after a strong physical exercise. Myelography and MRI were the diagnostic tools. Surgical decompression improved the signs and symptoms in both cases. Spinal epidural cavernous hemangiomas are rare lesions that are usually regarded as vascular hamartomas. Symptom onset may be insidious or acute and the prognosis after timely surgery is better when compared with that of intrathecal cavernous hemangiomas. The histology and treatment of these processes are discussed.
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We report a patient with a chronic intramedullary spinal cord abscess who suffered an episode of acute meningitis due to rupture of the abscess into the subarachnoid space.
The clinical presentation and treatment of three cases of acoustic schwannoma occurring in children are described. All the tumors were detected late, when they had attained a large size and were extremely vascular. The use of preoperative tumor embolization as an adjunct to surgical excision is discussed.
We report an unusual case of cerebral hydatid cyst which was found with CT. Unenhanced CT showed a hyperdense, not calcified, ring surrounding the cyst cavity. This has never been reported before. We propose a possible explanation for such abnormal behaviour.
A 50-year-old man with a right hemiparesis was found to have a cavernous malformation in the left thalamus. The diagnosis was made using magnetic resonance (MR) imaging. The vascular malformation was totally removed by means of a transcallosal interhemispheric surgical approach, but the patient's neurological deficit worsened. The role of MR imaging in establishing the diagnosis is emphasized and other published cases with thalamic locations are reviewed.
We present three cases of multiple sclerosis (MS) with tumoural manifestation during the disease in two cases, and as the first symptom in one case. Surgery is the first option, when a new patient presents with clinical features suggestive of a brain tumour. When an MS patient presents with these symptoms, corticoid treatment should be initiated and only if mass effect in computerized tomography (CT) persists, should surgery be considered.
Cavernous malformations located in the dura are rare. We present a case of a large cavernous malformation located in the anterior fossa and implanted in the dura of a pregnant woman. It showed great vascularization on an angiogram, and resembled a meningioma on computed tomographic scan. The operation was difficult because of the tumor's great vascularity and profuse bleeding.
A 67-year-old man with a 1 1/2-month history of spastic paraparesis caused by a dorsal intradural disc herniation underwent surgical treatment via a posterior approach. Dorsal herniated discs are rare, and intradural dorsal disc herniations are even more infrequent. Including this case, the medical literature reviewed describes only four such cases.
A case of a cerebrovascular varix located in the right lateral ventricle is reported. The patient suffered intraventricular and subarachnoid hemorrhages. The intraventricular varix was coagulated and excised.
A 34-year-old woman presented with progressive loss of vision in her left eye of 2 months' evolution. Computerized tomography showed a hypodense lesion in the suprasellar region. At surgery a cystic lesion was found inside the optic nerve. Histological study proved it to be a neuroepithelial cyst. The pathogenesis of a neuroepithelial cyst in such an exceptional site is discussed.
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OBJECTIVE: We examine a possible protective effect from growth hormone (GH) against radiation in cell cultures of rat embryon brain cortex. MATERIALS AND METHODS: Brain cortexes were removed from rat embryos of 17 days development and prepared for cell culture. The culture medium of half the plates was enriched with 500 ng/ml GH. All plates received a radiation dose of 3 Gy per plate and were again incubated for 24 hours. The TUNEL technique was employed to verify cell apoptosis in the irradiated plates and compare its level in plates with and without GH. CONCLUSIONS: We observed that irradiated cultures with GH had significantly less cell apoptosis than those without GH and concluded that this hormone excercised a protective effect on the cell cultures. The present study demonstrated the protective effect from GH in rat embryonary cells and suggests the need for future in vitro and in vivo studies using central nervous system cells.
Previous reports have shown that unrecognized or incidental bile duct varices have been reported as being related to hazardous complications and difficulties during surgery or other interventional procedures. A 32-year-old Indian female patient with no previous symptoms and signs suggestive of portal hypertension was admitted for an elective laparoscopic cholecystectomy for biliary colic. Bile duct varices were incidentally recognized during the operation. For the sake of safety, the surgery was converted to a conventional approach. Postoperatively, a detailed history revealed catheterization of the umbilical vein during the newborn period. Subsequently, contrast-enhanced computer tomography scanning showed extrahepatic portal vein thrombosis and cavernous transformation, while an upper gastrointestinal tract endoscopy did not reveal any evidence of esophageal varices. Bile duct varices should be excluded in patients with symptoms and signs suggestive for portal hypertension. Moreover, the present case addresses the fact that bile duct varices should also be suspected in asymptomatic patients with a history suggestive for extrahepatic portal vein thrombosis. Intraoperative recognition of bile duct varices requires a careful anatomical approach to the hepatoduodenal ligament to avoid hazardous complications.
We present 11 patients with intracranial gangliogliomas. The age ranged between 4 and 69 years with a mean of 32 years. The most frequent clinical manifestations were epilepsy in 7 cases and headache in 4 cases, and had begun from 15 days to 12 years before diagnosis. The gangliogliomas were located supratentorially predominantly in the temporal lobe (5 cases), except one, which was located within the cerebellum, which is extremely rare. EEG evidenced focality in 8 cases. The CT scan showed hypo or isodense images which were often associated with cysts, and that partially or totally enhanced with contrast administration in 7 cases (63.3%). Calcification was seen in only one case (9%). All our cases were treated surgically. Three patients were reoperated for recurrence. One case was reoperated twice and the histologic study showed astrocytoma grade II. Radiotherapy was given in two cases. In one case after subtotal surgery and in the other after the second operation for recurrence. Follow-up ranged between one and thirteen years, with a mean of 6.8 years. There was only one death. We used the CT scan for follow-up. However, nowadays MRI is more useful than the CT scan to distinguish recurrences.
Patients with multiple sclerosis may present clinical data suggestive of cerebral tumor. It has been accepted that multiple sclerosis failed to show expansive signs in the computerized tomography (CT). However, since 1979 a total number of 13 patients have been reported to have expansive images at the CT. We report 3 cases with clinical symptoms suggesting a cerebral tumor associated with expansive signs at the CT. The subsequent follow-up of these patients confirmed the diagnosis of clinically defined multiple sclerosis. The management of these patients is difficult. Those patients with previous history suggestive of multiple sclerosis should be probably treated with steroids and followed with serial CT. If a clear recovery was not achieved in a relatively short term, a cerebral biopsy is recommended to rule out a neoplasm. When the clinical presentation begins with signs suggestive of a neoplasm, the cerebral biopsy is recommended.
A 68-year-old woman with a subarachnoid hemorrhage was operated on for an anterior communicating artery aneurysm demonstrated by angiography. A month later she developed intestinal hemorrhage and a selective angiography showed multiple aneurysmatic dilatations, which were compatible with angiodysplasia, to be the cause of the intestinal bleeding. This association of intracranial and extracranial aneurysms is infrequent.