RESUMO
Posterior fossa ischemia is not a very frequent situation. It is responsible for about 25% of all ischemic strokes, and the vast majority of the cases are related to atherosclerotic stenosis of the vertebral and/or basilar arteries. Acute ischemia can also occur in the setting of vertebral artery dissection, traumatic or spontaneous. Recently, blunt trauma has been increasingly recognized as a cause for craniocervical artery injury. The management options for both traumatic and atherosclerotic lesions of the posterior fossa are still under debate. We present a case of a delayed onset of hemodynamic ischemic symptoms due to bilateral vertebral artery occlusion probably related to remote trauma to the head and neck in a 55-year-old-man treated successfully with extracranial to intracranial bypass.
Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/cirurgia , Revascularização Cerebral/métodos , Artéria Vertebral , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Angiografia Cerebral , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Posterior fossa ischemia is not a very frequent situation. It is responsible for about 25 percent of all ischemic strokes, and the vast majority of the cases are related to atherosclerotic stenosis of the vertebral and/or basilar arteries. Acute ischemia can also occur in the setting of vertebral artery dissection, traumatic or spontaneous. Recently, blunt trauma has been increasingly recognized as a cause for craniocervical artery injury. The management options for both traumatic and atherosclerotic lesions of the posterior fossa are still under debate. We present a case of a delayed onset of hemodynamic ischemic symptoms due to bilateral vertebral artery occlusion probably related to remote trauma to the head and neck in a 55-year-old-man treated successfully with extracranial to intracranial bypass.
Acidentes vasculares cerebrais (AVC) isquêmicos no sistema vertebro-basilar não são frequentes. Representam cerca de 25 por cento dos AVCs isquêmicos, e a maioria é relacionada com aterosclerose das artérias vertebrais e/ou basilar. Isquemia aguda pode também ser resultado de dissecções da artéria vertebral, traumáticas ou espontâneas. Recentemente, traumatismos fechados têm sido cada vez mais reconhecidos como causa de lesão das artérias craniocervicais, podendo ou não resultar em sintomas isquêmicos. O tratamento para estas lesões, sejam traumáticas ou ateroscleróticas, ainda é motivo de debate. Relatamos o caso de um homem de 55 anos com sintomas isquêmicos, hemodinâmicos, tardios, devido a oclusão bilateral das artérias vertebrais, provavelmente relacionada a lesão traumática das artérias vertebrais, tratada com sucesso com bypass extra-intracraniano.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/cirurgia , Revascularização Cerebral/métodos , Artéria Vertebral , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas , Isquemia Encefálica/etiologia , Isquemia Encefálica , Angiografia Cerebral , Resultado do TratamentoRESUMO
Cavernous malformations of the brainstem (CMB) occur less commonly in children than in adults. Their appearance is even rarer in infants, with only five cases reported in the literature. The authors report two additional cases in which giant CMBs were diagnosed in two infants, one when the patient was 1 month old and the other when the patient was 15 months old. A median suboccipital approach in one patient and a pterional-orbitozygomatic approach in the other were used to obtain complete resection of the malformations. Excellent outcomes were achieved in both children. A review of the literature is also presented. It seems that CMBs in infants usually follow a progressive course of growth and associated neurological deterioration. Patients with symptomatic lesions abutting the pial surface should undergo surgical treatment with the goal of cure. An increase may be expected in the number of CMBs diagnosed in children as a result of regular screening of relatives with the familial form of the disease. Nevertheless, due to the small confines of the brainstem, incidental or asymptomatic CMB should still be extraordinary. In the case of such a rare occurrence, conservative treatment should be advocated.
Assuntos
Tronco Encefálico/anormalidades , Tronco Encefálico/irrigação sanguínea , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.