RESUMO
INTRODUCTION: Spinal epidural haematomas are rare entities associated to spinal traumatic injuries and vascular lesions or which can appear spontaneously. There are no direct reports linking them to heart surgery. CASE REPORT: We report the case of a female aged 43 years who underwent surgery to change a mitral valve because of a rheumatic heart disease, and who, from the immediate post operative period onwards, presented paraplegia with a sensory and motor level that reached C3, breathing troubles and quadriplegia. Diagnosis was performed in five days because it was thought that she was suffering from an ischemic spinal cord infarction. Spiral computerised tomography scans revealed an epidural haematoma of the whole spinal cord from C2 to T12, with acute spinal cord compression. Ingurgitation of the epidural venous plexus and venous hypertension were also observed. CONCLUSION: The study of a growing motor and sensory deficit in a patient with immediate heart surgery must include early imaging in order to rule out a space occupying pathology, such as a spinal epidural haematoma. This case is singular because of the extension involved and the fact that it is directly linked with heart surgery procedure.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/patologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Adulto , Vértebras Cervicais , Diagnóstico Diferencial , Feminino , Humanos , Vértebras Torácicas , TomografiaRESUMO
The concept of Chaos has proven to be one of the greatest scientific advances that have led to radical philosophical implications. It deals with dynamic systems whose determining factors are completely unknown to us. Sometimes it seems that these dynamic systems exhibit a stochastic behavior while others portray simpler or better known behaviors where determinism is obvious. When the physician faces chaotic, dynamic systems, he or she wonders if it is healthy for these biologic systems to be chaotic. When analyzing the variation in brain and heart rates mathematically, the conclusion is that these rates are chaotic, complicated and unpredictable. Because each organ regulates its own performance, the mathematical variations seem to be the result of the organ's determinism rather than fluctuation. This healthy variability is neither a random nor an uncontrolled fluctuation. It is a certain, well-harmonized chaos, that 'provides the body with the flexibility to respond to different stimuli'.
Assuntos
Encéfalo/anatomia & histologia , Frequência Cardíaca , Dinâmica não Linear , Animais , Humanos , Modelos TeóricosRESUMO
We describe a case in which an incidental left carotid aneurysm was found during the preoperative evaluation of a pituitary adenoma. After magnetic resonance imaging (MRI) and angiography delineated their characteristics, we chose to treat both lesions simultaneously through a left supraorbital keyhole approach. The aneurysm clipping was followed by intracapsular resection of the tumor that was identified later as a non-secretory adenoma. The postoperative course was uneventful. This case shows that in carefully selected patients it is possible to treat successfully concurrent conditions through a minimally invasive approach, with the well known advantages of low morbidity and a short hospital stay.
Assuntos
Adenoma Cromófobo/cirurgia , Doenças das Artérias Carótidas/cirurgia , Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Neoplasias Hipofisárias/cirurgia , Adenoma Cromófobo/complicações , Adenoma Cromófobo/diagnóstico , Angiografia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Resultado do TratamentoRESUMO
Four cases are reported of juvenile familial amyotrophic lateral sclerosis (JFALS) with exceptionally long survival (mean=27 years), and consequent development of dementia. Subjects' mean age at onset was 15.7 years. Their clinical features and electrophysiological findings support the diagnosis. One subject's MRI scan showed severe atrophy to the cortex and brain stem; wallerian degeneration in the pyramidal pathway, as reported in other studies, could not be found. JFALS is characterized by the involvement of other neuronal systems not present in the adult form and by long survival after disease onset.
Assuntos
Esclerose Lateral Amiotrófica/patologia , Expectativa de Vida , Adolescente , Adulto , Idade de Início , Esclerose Lateral Amiotrófica/mortalidade , Encéfalo/patologia , Criança , Demência , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoAssuntos
Esclerose Lateral Amiotrófica/mortalidade , Feminino , Previsões , Humanos , Masculino , México , Pessoa de Meia-Idade , Análise de SobrevidaRESUMO
We report a partially retrospective and longitudinal study of patients with optic neuritis (ON) that developed multiple sclerosis (MS). We assessed clinical features or factors that might differentiate these patients from those with ON that did not develop MS. Of the cases followed, 110 (67%) were found to have an idiopathic origin of the disease; whereas 55 (33%) were found to develop it secondary to another disease. Of the 110 idiopathic cases, 13 (12%), developed MS over an average of 2 years. The results of these patients in the laboratory analyses of blood and CSF as well as the results of the MRI and evoked potential studies, were significantly different from the ON patients without MS. We conclude that the percentage of patients with ON in our sample that developed MS is similar to that found in Japan and is relatively low in comparison to other reports.
Assuntos
Esclerose Múltipla/fisiopatologia , Neurite Óptica/fisiopatologia , Adulto , Diagnóstico Diferencial , Progressão da Doença , Potenciais Evocados Visuais , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , México , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Neurite Óptica/sangue , Neurite Óptica/líquido cefalorraquidiano , Neurite Óptica/etiologia , Neurite Óptica/patologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze the incidence and clinical characteristics of MND (Motor Neuron Diseases) in a Mexican institution. MATERIAL AND METHODS: It was a retrospective study, of 274 definitive MND patients seen in a neurological reference hospital of Mexico City during the period of 1965-1995 (248 as Amyotrophic Lateral Sclerosis, 15 as Progressive Bulbar Palsy, 8 as Primary Lateral Sclerosis and 3 as Progressive Spinal Atrophy). RESULTS: The frequency of MND increased gradually in our institution in the 31 years revised. The mean age of onset in our series was approximately 48 years in contrast to a higher age found in other series. The clinical features are similar to those found elsewhere. CONCLUSIONS: Our study showed that the frequency of MND is increasing in Mexico in a similar fashion to that observed in the rest of the world. This makes conceivable that the incidence of MND in Mexico may also resemble the figures reported worldwide. Prospective population studies are required to establish the incidence of MND in Mexico.