RESUMO
Introducción: el absceso epidural posterolateral y la compresión radicular es una rara complicación del absceso retrofaríngeo (ARF). Se realizó el reporte de un caso con esta complicación extremadamente rara. Método: reporte de caso y revisión de la literatura (estudios radiológicos, historia y hallazgos clínicos). Se firmó consentimiento del paciente para la publicación. Resultados: paciente de 33 años remitido a nivel terciario de atención con un cuadro clínico de cervicalgia, odinofagia y fiebre. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) mostraron una colección retrofaríngea con compromiso epidural en el espacio medular cervical; en el examen físico se encontró odinofagia, cervicalgia, fiebre y pérdida de la fuerza muscular en el miembro superior derecho. El paciente fue llevado a manejo quirúrgico por otorrinolaringología y ortopedia para el drenaje de la colección; además, se le administró antibioticoterapia con cefepime y clindamicina por 21 días con buenos resultados; se consideró que el origen del absceso era idiopático. Conclusiones: el absceso epidural y la compresión radicular secundarias a un ARF es una rara y potencialmente mortal complicación de esta patología, con secuelas importantes en el paciente que la padece, que requiere un manejo médico-quirúrgico. En nuestro caso el manejo fue interdisciplinario, ya que integró otorrinolaringología, ortopedia, infectología y fisioterapia, lo que resultó en una evolución satisfactoria del paciente.
Introduction: posterolateral epidural abscess and radicular compression is a rare complication of retropharyngeal abscess (RFA), a case report with this extremely rare complication was made. Method: case report and review of the literature (radiological studies, clinical history, clinical findings) patient's consent was signed for the publication. Results: a 33-year-old patient referred at the tertiary care level with a clinical picture of cervicalgia, odynophagia and fever; CT and MRI showed retropharyngeal collection with epidural involvement in the cord cervical space, physical examination, odynophagia, cervicalgia, fever and loss of muscle strength in the right upper limb. Led to surgical management by ENT and orthopedics column for drainage of the collection; antibiotic therapy with cefepime, clindamycin for 21 days with good results; It was considered of idiopathic origin. Conclusions: epidural abscess and root compression secondary to an RFA is a rare and potentially fatal complication of this pathology with important sequelae in the patient, which requires medical-surgical management, in our case the management was integrated interdisciplinary otolaryngology, orthopedics, infectology, physiotherapy , with satisfactory evolution in the patient.
Assuntos
Humanos , Masculino , Adulto , Medula Espinal , Infecções Estafilocócicas/complicações , Abscesso Retrofaríngeo/complicações , Abscesso Epidural/etiologia , Síndromes de Compressão Nervosa/etiologia , Infecções Estafilocócicas/terapia , Infecções Estafilocócicas/diagnóstico por imagem , Staphylococcus aureus/isolamento & purificação , Abscesso Retrofaríngeo/terapia , Abscesso Retrofaríngeo/diagnóstico por imagem , Abscesso Epidural/terapia , Abscesso Epidural/diagnóstico por imagem , Síndromes de Compressão Nervosa/terapia , Síndromes de Compressão Nervosa/diagnóstico por imagemRESUMO
SUMMARY: During routine dissection of a left upper limb of a 68-year-old male human cadaver, an unusual muscle was observed originating from the radius and flexor retinaculum, and continued in the hypothenar region with the muscle belly of the abductor digiti minimi. We checked that it was an accessory abductor digiti minimi (ADM). Its muscular belly was in close relation to the median and ulnar nerves. We review the literature regarding such muscle variations and discuss the potential for compression of the median and ulnar nerves. Although the accessory ADM is usually asymptomatic and only rarely results in nerve compression, it should be taken into account by surgeons when establishing a differential diagnosis in the compression neuropathies of the median and ulnar nerves. An ultrasound scanning can help establish the differential diagnosis.
RESUMEN: Durante la disección de rutina de un miembro superior izquierdo de un cadáver humano masculino de 68 años, se observó un músculo inusual que se originaba en el radio y el retináculo flexor del carpo, y continuuaba en la región hipotenar con el vientre muscular del abductor digiti minimi manus. Verificamos que se trataba del músculo abductor digiti minimi accessorius (ADMA). Su vientre muscular se encontraba en estrecha relación con los nervios mediano y ulnar. Revisamos la literatura sobre variaciones musculares y discutimos la potencial compresión de los nervios mediano y ulnar. Aunque el ADMA suele ser asintomático y rara vez produce compresión nerviosa, los cirujanos deben tenerlo en cuenta al establecer un diagnóstico diferencial en las neuropatías de compresión de los nervios mediano y ulnar. Una ecografía puede ayudar a establecer el diagnóstico diferencial.
Assuntos
Humanos , Masculino , Idoso , Músculo Esquelético/anormalidades , Síndromes de Compressão Nervosa/etiologia , Nervo Ulnar , Cadáver , Fatores de Risco , Síndromes de Compressão do Nervo Ulnar/etiologia , Neuropatia Mediana/etiologia , Nervo MedianoRESUMO
STUDY DESIGN: This is a level IV retrospective descriptive study at a single institution. OBJECTIVE: The objective of the study was to determine the preoperative signs or symptoms prompting cervicomedullary imaging in Jeune syndrome. SUMMARY OF BACKGROUND DATA: Jeune syndrome is a rare autosomal recessive disorder that results in pulmonary compromise from abnormal development of the thorax. Multiple medical comorbidities complicate timely diagnosis of cervicomedullary stenosis, which neurologically jeopardizes this patient population with regards to improper cervical manipulation. Currently, explicit screening of the cervicomedullary junction is not advocated in national guidelines. METHODS: The User Reporting Workbench and Center for Thoracic Insufficiency Syndrome (CTIS) Safety Registry was queried for patients with Jeune syndrome under the age of 18 with cervicomedullary stenosis with or without suboccipital craniectomy/craniotomy evaluated at the authors' institution from January 1, 2007 to August 21, 2018. The primary outcome was the clinical reason for cervicomedullary screening. Secondary outcomes were: age at time of surgery, preoperative myelopathy (spasticity, urinary retention), hydrocephalus, postoperative deficits (respiratory, motor, swallowing difficulty), and need for cervical fusion. RESULTS: Of 32 patients with Jeune syndrome, four (12.5%) had cervicomedullary stenosis requiring decompression. The average age at surgery was 5.25 months (2-9 mo). Two patients underwent imaging due to desaturation events while the other two patients were diagnosed with cervical stenosis as an incidental finding. No patients exhibited clinical myelopathy. Two patients had baseline preoperative swallowing difficulties. None of the patients postoperatively required cervical fusions, nor did they exhibit respiratory deficits, motor deficits, or worsening swallowing difficulties. CONCLUSION: Jeune patients should be routinely screened for cervicomedullary stenosis and undergo subsequent prophylactic decompression to minimize or eliminate the development of irreversible neurologic compromise. LEVEL OF EVIDENCE: 4.
Assuntos
Descompressão Cirúrgica , Síndrome de Ellis-Van Creveld/complicações , Síndrome de Ellis-Van Creveld/cirurgia , Síndromes de Compressão Nervosa/prevenção & controle , Estenose Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/etiologia , Humanos , Hidrocefalia/etiologia , Lactente , Síndromes de Compressão Nervosa/etiologia , Procedimentos Neurocirúrgicos , Período Pós-Operatório , Estudos Retrospectivos , Medula Espinal , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Estenose Espinal/prevenção & controleRESUMO
PURPOSE: The suprascapular artery originates in the thyrocervical trunk; however, several variations regarding both the origin and the path have already been described. This article aims to describe a complex and rare variation of the suprascapular artery originating as a branch of the subscapular artery. We described, reviewed the literature, and highlighted the clinical relevance of such variations to the medical practice. METHODS: A routine dissection was performed on a male adult cadaver approximately 60-70 years old, embalmed in formalin 10%. In addition, the diameter of the axillary, subscapular and suprascapular arteries was measured. RESULTS: During the dissection, we identified the suprascapular artery emerging from the medial side of the subscapular artery with a long and tortuous pathway to the supraspinatus fossa, under the superior transverse scapular ligament. Associated with this, three other anatomical variations stand out: the posterior circumflex humeral artery emerging from the subscapular artery, the absence of the anterior circumflex humeral artery, and two pectoral branches emerging from the third part of the axillary artery and from the subscapular artery, respectively. CONCLUSION: Such variations are of great clinical relevance to orthopedists, mastologists, vascular surgeons and other specialties for both surgical approaches and suprascapular neuropathy.
Assuntos
Variação Anatômica , Artérias/anormalidades , Escápula/irrigação sanguínea , Idoso , Cadáver , Humanos , Ligamentos Articulares/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Articulação do Ombro/irrigação sanguínea , Articulação do Ombro/inervação , Articulação do Ombro/cirurgiaRESUMO
INTRODUCTION:: Insertion of central catheters in peripheral vessels is a common procedure performed for a variety of indications, including parenteral nutrition. Hyperemesis gravidarum may require parenteral nutrition in exceptional situations. Although globally safe, insertion of peripherally inserted central catheters (PICCs) can lead to complications. CASE REPORT:: We describe a case of a pregnant woman who required parenteral nutrition and underwent an unsuccessful PICC insertion attempt resulting in arterial puncture, and who 34 days later presented with right upper limb paresthesia. A pseudoaneurysm with nerve compression was diagnosed and treated by open surgery, without maternal or fetal complications. CONCLUSION:: We recommend active surveillance ultrasound (e.g. in the first 24-48 h) of unsuccessful PICC insertion attempts, because late complications may occur and require invasive procedures for treatment.
Assuntos
Artéria Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Cateterismo Periférico/efeitos adversos , Hiperêmese Gravídica/terapia , Síndromes de Compressão Nervosa/etiologia , Nutrição Parenteral , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Artéria Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Hiperêmese Gravídica/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Gravidez , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Adulto JovemRESUMO
The quadrangular space is a space in the axilla bounded by the inferior margin of the teres minor muscle, the superior margin of the teres major muscle, the lateral margin of the long head of the triceps brachii muscle and the surgical neck of the humerus, medially. The axillary nerve (C5-C6) and the posterior circumflex humeral artery and veins pass through this space in order to supply their territories. The subscapularis muscle is situated into the scapular fossa and inserts itself into the lesser tubercle of the humerus, thus helping stabilize the shoulder joint. A supernumerary muscle known as accessory subscapularis muscle originates from the anterior surface of the muscle and usually inserts itself into the shoulder joint. It is a rare variation with few reports of its existence and incidence. We present a case of the accessory subscapularis muscle in a male cadaver fixated with a 10% formalin solution. The muscle passed anteriorly to the axillary nerve, thus, predisposing an individual to quadrangular space compression syndrome. We perform a review of the literature and address its clinical, anthropological and anatomical significance.
Assuntos
Variação Anatômica , Plexo Braquial/anatomia & histologia , Músculo Esquelético/anormalidades , Síndromes de Compressão Nervosa/etiologia , Articulação do Ombro/anormalidades , Artéria Axilar/anatomia & histologia , Cadáver , Humanos , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/inervação , Articulação do Ombro/irrigação sanguínea , Articulação do Ombro/inervaçãoRESUMO
The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. The prevalence of LN was based on the presence of ≥1 abnormal PSSD pressure threshold for a two-point static touch. A total of 312 upper and lower extremity nerves were evaluated in 39 patients. The PSSD found a 97.4% prevalence of LN. Tinel's sign was identified in 60% of these patients. An algorithm for early identification of patients with LN was proposed using PSSD testing based on the unilateral screening of the ulnar and deep peroneal nerves.
Assuntos
Extremidades/inervação , Hanseníase , Síndromes de Compressão Nervosa , Exame Neurológico , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso de 80 Anos ou mais , Algoritmos , Criança , Estudos Transversais , Diagnóstico Precoce , Equador/epidemiologia , Feminino , Humanos , Hanseníase/complicações , Hanseníase/epidemiologia , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/fisiopatologia , Exame Neurológico/instrumentação , Exame Neurológico/métodos , Seleção de Pacientes , Limiar Sensorial , TatoRESUMO
Nerve compression by anomalous muscles located at the wrist and distal forearm is an infrequent condition. Accessory muscles may compress underlying structures in the Carpal Tunnel region or ulnar canal , producing pain and paresthesia. Two cases of ulnar and median nerve compression, caused by prominent accessory muscles at the distal forearm, are described. Literature review is presented.
La compresión nerviosa causada por vientres musculares anómalos localizados en la muñeca y en el tercio distal del antebrazo es una condición poco frecuente. Músculos accesorios pueden comprimir estructuras subyacentes en la región del túnel del carpo o en el canal de ulnar, produciendo dolor y parestesia. Se presentan dos casos de compresión de los nervios ulnar y mediano en el tercio distal del antebrazo, causados por vientres musculares prominentes de músculos accesorios del antebrazo. Se presenta una revisión de la literatura.
Assuntos
Humanos , Masculino , Feminino , Adulto , Variação Anatômica , Antebraço/anormalidades , Músculo Esquelético/anormalidades , Síndromes de Compressão Nervosa/etiologiaRESUMO
OBJECTIVE: Trigeminal neuralgia is a debilitating facial pain disorder, frequently caused by vascular compression of the trigeminal nerve. Vascular compression that results in trigeminal neuralgia occurs along the cisternal segment of the nerve. CONCLUSION: Imaging combined with clinical information is critical to correctly identify patients who are candidates for microvascular decompression. The purpose of this article is to review trigeminal nerve anatomy and to provide strategies for radiologists to recognize important MRI findings in patients with trigeminal neuralgia.
Assuntos
Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/etiologia , Nervo Trigêmeo/anatomia & histologia , Neuralgia do Trigêmeo/diagnóstico , Doenças Vasculares/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Nervo Trigêmeo/patologia , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Doenças Vasculares/cirurgiaRESUMO
AIM OF THE VIDEO / INTRODUCTION: Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105-11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756-8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves. METHOD: Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots. RESULT: After surgery, the patient with the sciatic entrapment showed full recovery of the sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms. CONCLUSION: The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.