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[PMID]:28452710
[Au] Autor:Loftus PA; Wise SK; Daraei P; Baugnon K; DelGaudio JM
[Ad] Endereço:Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
[Ti] Título:Excavating meningoencephaloceles: A newly recognized entity.
[So] Source:Am J Rhinol Allergy;31(2):127-134, 2017 Mar 01.
[Is] ISSN:1945-8932
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks are largely attributed to idiopathic intracranial hypertension and typically present as skull base defects with or without prolapse of intracranial contents. However, in our practice, we have encountered a distinct type of spontaneous CSF leak that presents in a different manner. OBJECTIVE: To discuss a newly-classified, difficult to treat, subset of spontaneous CSF leaks that present as excavation of the bone of the skull base in a tunnel- or canal-like fashion by a meningocele or meningoencephalocele instead of as a localized area of bony dehiscence. METHODS: A retrospective review was performed at a tertiary care rhinology practice to identify a subset of CSF leak patients with an excavating/canal-like skull base defect visualized radiographically on computed tomography (CT) scan or magnetic resonance imaging and/or endoscopically in the operating room. RESULTS: The cohort of patients consisted of 7 females and 1 male with an average age of 53.6 years and a self-reported race of 4:3:1 African-American:Caucasian:Indian. All patients presented with CSF rhinorrhea. The most common leak site was the cribriform and upper septum. Six of the 8 patients had multiple defects and/or progression of their skull base defects, and 5 patients required multiple and/or repeat repairs in the operating room. Seven of the 8 patients underwent a cisternogram because the excavating nature of the leaks made it difficult to identify the specific leak site on high-resolution CT scan alone. CONCLUSION: In spontaneous CSF leaks that are difficult to identify or recur soon after a proper repair, an excavating pattern should be considered. Failure to recognize this type of leak and all of its tributaries, to fully unroof the excavated bone to completely resect the meningocele, and to visualize and close the site of origin will likely result in failure and recurrence of CSF leak.
[Mh] Termos MeSH primário: Vazamento de Líquido Cefalorraquidiano/diagnóstico
Encefalocele/diagnóstico
Meningocele/diagnóstico por imagem
Base do Crânio/diagnóstico por imagem
Base do Crânio/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Vazamento de Líquido Cefalorraquidiano/cirurgia
Encefalocele/cirurgia
Endoscopia
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meningocele/cirurgia
Meia-Idade
Base do Crânio/cirurgia
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2500/ajra.2017.31.4413


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[PMID]:29313370
[Au] Autor:Alvi SA; Jones JW; Lin J
[Ad] Endereço:1 Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
[Ti] Título:Bilateral Ossicular Head Dehiscence Into the Middle Cranial Fossa.
[So] Source:Ann Otol Rhinol Laryngol;127(3):209-212, 2018 Mar.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To describe a unique case of bilateral dehiscence of the malleus and incus heads into the middle fossa making contact with the temporal lobes, along with its clinical implications. METHODS: An analysis of a patient case and review of pertinent literature were performed. RESULTS: A patient with a history of right-sided mastoidectomy for cholesteatoma was evaluated for persistent conductive hearing loss. On computed tomography (CT) and magnetic resonance imaging (MRI), the patient had a complete dehiscence of the tegmen tympani on the right, with ossicular heads being located above the floor of the middle cranial fossa. A similar finding to a milder degree was noted on the left. The patient underwent revision tympanoplasty with mastoidectomy with removal of the incus and ossicular chain reconstruction and middle fossa craniotomy for repair of the right epitympanic dehiscence. CONCLUSIONS: We present some of the unique imaging and operative findings involved in an unusual presentation of encephalocele in which the bilateral malleus and incus heads rise above the level of the middle fossa floor.
[Mh] Termos MeSH primário: Colesteatoma/cirurgia
Fossa Craniana Média
Encefalocele
Perda Auditiva Condutiva
Mastoidectomia/efeitos adversos
Reoperação/métodos
Timpanoplastia/métodos
[Mh] Termos MeSH secundário: Adulto
Fossa Craniana Média/diagnóstico por imagem
Fossa Craniana Média/patologia
Encefalocele/diagnóstico
Encefalocele/etiologia
Perda Auditiva Condutiva/diagnóstico
Perda Auditiva Condutiva/etiologia
Seres Humanos
Imagem por Ressonância Magnética/métodos
Masculino
Mastoidectomia/métodos
Complicações Pós-Operatórias/diagnóstico
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417751956


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[PMID]:28468209
[Au] Autor:Ramdial S; Pillay T; Madaree A
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
[Ti] Título:Management of a Large Frontal Encephalocoele With Supraorbital Bar Remodeling and Advancement.
[So] Source:J Craniofac Surg;28(3):e251-e254, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Of all the craniofacial abnormalities, facial clefts are the most disfiguring. Facial clefts are classified according to the affected anatomical area as described by Tessier. Through this classification, the location and extent of the cleft can be designated numerically.A 2-month-old male infant was referred to authors' craniofacial unit, from a hospital in a rural province of South Africa, with a problem of a supranasal encephalocoele. Bilateral raised eyebrows were noted as was a right-sided upper lid central third coloboma. Computed tomography and magnetic resonance imaging scans confirmed the presence of a supranasal encephalocoele with a large frontal bone defect and splayed nasal bones. Bilateral enlarged orbits were noted with tented orbital roofs that we classified as Tessier number 10 facial clefts. The child was booked for an encephalocoele excision and calvarial reconstruction at 4 months of age.As a result of the encephalocoele, the supraorbital bar with its adjacent nasal bones was cleaved in 2, resulting in a significant frontal bone defect. Osteotomies were performed to remove the supraorbital bar and nasal bones from the calvarium. The supraorbital bar segment was remodeled and plated with absorbable poly-L-lactic acid plates. Osteotomies of the nasal bones allowed them to be united centrally, also with absorbable plates. This entire construct was transferred and secured to the calvarium, but in a more caudal position thereby obliterating the frontal bone and Tessier number 10 facial cleft defects with a naturally contoured construct.
[Mh] Termos MeSH primário: Anormalidades Múltiplas/cirurgia
Anormalidades Craniofaciais/cirurgia
Encefalocele/cirurgia
Osso Frontal/anormalidades
Osso Nasal/anormalidades
Órbita/anormalidades
Procedimentos Ortopédicos/métodos
[Mh] Termos MeSH secundário: Placas Ósseas
Osso Frontal/cirurgia
Seres Humanos
Lactente
Masculino
Osso Nasal/cirurgia
Órbita/cirurgia
Procedimentos Ortopédicos/instrumentação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003474


  4 / 3180 MEDLINE  
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[PMID]:29178892
[Au] Autor:White RJ; Wang Y; Tang P; Montezuma SR
[Ad] Endereço:Department of Ophthalmology and Visual Neurosciences, University of Minnesota, 420 Delaware St. SE, MMC 493, Minneapolis, MN, 55455-0501, USA.
[Ti] Título:Knobloch syndrome associated with Polymicrogyria and early onset of retinal detachment: two case reports.
[So] Source:BMC Ophthalmol;17(1):214, 2017 Nov 25.
[Is] ISSN:1471-2415
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Knobloch Syndrome (KS) is a rare congenital syndrome characterized by occipital skull defects and vitreoretinal degeneration. Retinal detachment (RD) often occurs at the end of the first decade of life or later. Aside from occipital skull defects, central nervous system abnormalities are uncommon. CASE PRESENTATIONS: We report on two siblings with KS. The first, a seven month old male, presented with nystagmus and was found to have a serous RD and a tessellated retinal appearance. His sister had a history of multiple visual abnormalities and had a similar retinal appearance although no signs of RD, but retina staphylomas. Genetic testing performed on both siblings showed a mutation in COL18A1, diagnostic of KS. MRI of both siblings demonstrated polymicrogyria but did not show occipital defects. CONCLUSIONS: Although several families with KS have been described previously, our case is noteworthy for several reasons. The RD observed in our first patient occurred at an early age, and we find evidence of only one patient with KS who had an RD identified at an earlier age. The findings of polymicrogyria are not characteristic of KS, and we found only a few previous reports of this association. Additionally, we review potential treatment options for this condition.
[Mh] Termos MeSH primário: Encefalocele/complicações
Polimicrogiria/etiologia
Descolamento Retiniano/congênito
Descolamento Retiniano/etiologia
[Mh] Termos MeSH secundário: Adolescente
Anisometropia/etiologia
Feminino
Seres Humanos
Lactente
Masculino
Miopia Degenerativa/etiologia
Descolamento Retiniano/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1186/s12886-017-0615-z


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[PMID]:28885087
[Au] Autor:Gandhoke GS; Goldschmidt E; Kellogg R; Greene S
[Ad] Endereço:Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
[Ti] Título:Encephalocele development from a congenital meningocele: case report.
[So] Source:J Neurosurg Pediatr;20(5):419-422, 2017 Nov.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A fetal MRI study obtained at 21 weeks' gestation revealed a suboccipital meningocele without hydrocephalus. One day after term birth, MRI demonstrated an acquired cerebellar encephalocele, and MRI obtained 5 months later showed progressive enlargement of the encephalocele, still without obvious hydrocephalus. The patient underwent an operation in which an external ventricular drain was placed, the grossly normal cerebellum was reduced into the posterior fossa without resection, and the dural defect was closed. The drain was weaned out over 5 days, and no ventriculoperitoneal shunt was placed. Postoperative MR images revealed normal cerebellum and no hydrocephalus. The patient is developmentally normal. Meningocele and encephalocele are embryologically distinct. An acquired encephalocele could develop from hydrocephalus (which was not present in this case), or secondary to the lower resistance to expansion into the dural defect of the meningocele relative to the resistance to expansion of the fetal skull. The cerebellar tissue was normal in this case, and was thus preserved. The developmental prognosis is excellent. To the authors' knowledge, this is the first reported case of this occurrence. It is important to differentiate between congenital and acquired encephalocele etiologies, because resection of the cerebellar tissue in an acquired encephalocele (as is routinely done in cases of congenital encephalocele) would be expected to result in neurological deficits.
[Mh] Termos MeSH primário: Encefalocele/etiologia
Meningocele/complicações
[Mh] Termos MeSH secundário: Encéfalo/diagnóstico por imagem
Encéfalo/crescimento & desenvolvimento
Encéfalo/cirurgia
Encefalocele/diagnóstico por imagem
Encefalocele/cirurgia
Feminino
Seres Humanos
Lactente
Imagem por Ressonância Magnética
Meningocele/diagnóstico por imagem
Meningocele/cirurgia
Diagnóstico Pré-Natal
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.3171/2017.6.PEDS17178


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[PMID]:28802374
[Au] Autor:Verma RK; Kaur N
[Ad] Endereço:Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: roshanverma@hotmail.com.
[Ti] Título:Secondary encephalocele in infant following subdural empyema repaired endoscopically-A case report.
[So] Source:Int J Pediatr Otorhinolaryngol;100:211-215, 2017 Sep.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Subdural empyema (SDE) is an uncommon entity, mostly associated with meningitis and can be life threatening in infants. Rarely, a subdural empyema can lead to nasal encephalocele which can be challenging situation to manage especially in infant. We present a case of 7 month old infant who presented with subdural empyema that led to formation of nasal encaphalocele after 4 months which was managed endoscopic route.
[Mh] Termos MeSH primário: Empiema Subdural/complicações
Encefalocele/etiologia
Meningite/complicações
[Mh] Termos MeSH secundário: Encefalocele/cirurgia
Endoscopia
Seres Humanos
Lactente
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170814
[St] Status:MEDLINE


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[PMID]:28780516
[Au] Autor:Chiloiro S; Giampietro A; Bianchi A; Tartaglione T; Capobianco A; Anile C; De Marinis L
[Ad] Endereço:Pituitary UnitDepartment of Endocrinology.
[Ti] Título:DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review.
[So] Source:Eur J Endocrinol;177(6):R275-R285, 2017 Dec.
[Is] ISSN:1479-683X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Primary empty sella (PES) is characterized by the herniation of the subarachnoid space within the sella, which is often associated with variable degrees of flattening of the pituitary gland in patients without previous pituitary pathologies. PES pathogenetic mechanisms are not well known but seem to be due to a sellar diaphragm incompetence, associated to the occurrence of upper sellar or pituitary factors, as intracranial hypertension and change of pituitary volume. As PES represents in a majority of cases, a neuroradiological findings without any clinical implication, the occurrence of endocrine, neurological and opthalmological symptoms, due to the above describes anatomical alteration, which delineates from the so called PES syndrome. Headache, irregular menses, overweight/obesity and visual disturbances compose the typical picture of PES syndrome and can be the manifestation of an intracranial hypertension, often associated with PES. Although hyperprolactinemia and growth hormone deficit represent the most common endocrine abnormalities, PES syndrome is characterized by heterogeneity both in clinical manifestation and hormonal alterations and can sometime reach severe extremes, as occurrence of papilledema, cerebrospinal fluid rhinorrhea and worsening of visual acuity. Consequently, a multidisciplinary approach, with the integration of endocrine, neurologic and ophthalmologic expertise, is strongly advocated and recommended for a properly diagnosis, management, treatment and follow-up of PES syndrome and all of the related abnormalities.
[Mh] Termos MeSH primário: Doenças Assintomáticas
Síndrome da Sela Vazia/diagnóstico
Encefalocele/diagnóstico
Hipófise/diagnóstico por imagem
Sela Túrcica/diagnóstico por imagem
Espaço Subaracnóideo/diagnóstico por imagem
[Mh] Termos MeSH secundário: Síndrome da Sela Vazia/diagnóstico por imagem
Síndrome da Sela Vazia/fisiopatologia
Síndrome da Sela Vazia/terapia
Encefalocele/diagnóstico por imagem
Encefalocele/fisiopatologia
Encefalocele/terapia
Hormônio do Crescimento Humano/deficiência
Hormônio do Crescimento Humano/secreção
Seres Humanos
Hiperprolactinemia/etiologia
Hiperprolactinemia/prevenção & controle
Hipertensão Intracraniana/etiologia
Hipertensão Intracraniana/prevenção & controle
Imagem por Ressonância Magnética
Neuroimagem
Papiledema/etiologia
Papiledema/prevenção & controle
Hipófise/fisiopatologia
Hipófise/secreção
Sela Túrcica/fisiopatologia
Índice de Gravidade de Doença
Espaço Subaracnóideo/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
12629-01-5 (Human Growth Hormone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170807
[St] Status:MEDLINE
[do] DOI:10.1530/EJE-17-0505


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[PMID]:28731403
[Au] Autor:Heidekrueger PI; Thu M; Mühlbauer W; Holm-Mühlbauer C; Schucht P; Anderl H; Schoeneich H; Aung K; Mg Ag M; Thu Soe Myint A; Juran S; Aung T; Ehrl D; Ninkovic M; Broer PN
[Ad] Endereço:Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich.
[Ti] Título:Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.
[So] Source:J Neurosurg Pediatr;20(4):334-340, 2017 Oct.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.
[Mh] Termos MeSH primário: Descompressão Cirúrgica/métodos
Encefalocele/cirurgia
Osso Frontal/cirurgia
Meningocele/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Masculino
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS1762


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[PMID]:28602933
[Au] Autor:Corbett MA; Turner SJ; Gardner A; Silver J; Stankovich J; Leventer RJ; Derry CP; Carroll R; Ha T; Scheffer IE; Bahlo M; Jackson GD; Mackey DA; Berkovic SF; Gecz J
[Ad] Endereço:Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide 5005, Australia.
[Ti] Título:Familial epilepsy with anterior polymicrogyria as a presentation of COL18A1 mutations.
[So] Source:Eur J Med Genet;60(8):437-443, 2017 Aug.
[Is] ISSN:1878-0849
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Knobloch syndrome [OMIM: (KNO1) #267750] is a rare and clinically heterogeneous autosomal recessive disorder caused by mutations in COL18A1. Knobloch syndrome is characterised by abnormalities of the eye and occipital skull defects however the full phenotypic spectrum is yet to be defined. This report describes a family of four affected sisters with polymicrogyria, refractory seizures, and intellectual impairment of varying severity with a Lennox-Gastaut phenotype, and complex eye abnormalities where a syndromic diagnosis was not initially made. Whole exome sequencing of two affected sisters followed by filtering for rare and potentially disease causing variants in all genes identified compound heterozygous variants in NM_030582.3 (COL18A1): c.3690G > A: p.(Trp1230*) and NM_030582.3 (COL18A1): c.4063_4064delCT: p.(Leu1355Valfs*72). The two variants co-segregated with the affected individuals in the family. Identification of COL18A1 mutations in individuals with a Lennox-Gastaut phenotype and anterior polymicrogyria but lacking the classical occipital encephalocele expands the COL18A1 clinical spectrum.
[Mh] Termos MeSH primário: Colágeno Tipo VIII/genética
Encefalocele/genética
Síndrome de Lennox Gastaut/genética
Mutação
Descolamento Retiniano/congênito
[Mh] Termos MeSH secundário: Adulto
Encefalocele/diagnóstico
Feminino
Heterozigoto
Seres Humanos
Síndrome de Lennox Gastaut/diagnóstico
Masculino
Meia-Idade
Linhagem
Fenótipo
Descolamento Retiniano/diagnóstico
Descolamento Retiniano/genética
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (COL18A1 protein, human); 0 (Collagen Type VIII)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE


  10 / 3180 MEDLINE  
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[PMID]:28583457
[Au] Autor:Janjua MB; Ivasyk I; Greenfield JP
[Ad] Endereço:Department of Neurological Surgery, Weill Cornell Medical College And New York Presbyterian Hospital, New York, New York, USA. Electronic address: mburhanj@gmail.com.
[Ti] Título:Vertebrobasilar Insufficiency Due to Distal Posterior Inferior Cerebellar Artery Compression in Chiari 1.5.
[So] Source:World Neurosurg;104:1050.e1-1050.e6, 2017 Aug.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Chiari malformation is characterized by radiographic evidence of herniation of cerebellar tonsils below the foramen magnum and a symptom complex of headaches; breathing, swallowing, or sleep difficulties; ataxia; restless; and motor and/or sensory deficits. CASE DESCRIPTION: We report a case of a 34-year-old woman whose imaging indicated a Chiari 1.5 with brainstem (caudal medulla) herniation and an expansive cervical syrinx. Her symptom complex showed signs both of cervical syringomyelia, as well as ones localizable to the medulla. An intradural exploration revealed the occlusion and caudal displacement of the loop of the right posterior inferior cerebellar artery, which was later confirmed via magnetic resonance angiography. CONCLUSIONS: In the setting of severe Chiari malformations, particularly the Chiari 1.5 variant, assessment of the posterior fossa vasculature may be useful in defining a subset of patients with preoperative compromise in posterior fossa blood flow and postoperative expectations. Preoperative planning and exploration of midline dorsal brain stem along with the tonsilomedullary fissure could be helpful for contribution of vascular pathology among Chiari symptoms complex in these patients.
[Mh] Termos MeSH primário: Malformação de Arnold-Chiari/cirurgia
Cerebelo/irrigação sanguínea
Encefalocele/cirurgia
Siringomielia/cirurgia
Insuficiência Vertebrobasilar/cirurgia
[Mh] Termos MeSH secundário: Adulto
Malformação de Arnold-Chiari/complicações
Angiografia Cerebral
Descompressão Cirúrgica
Encefalocele/etiologia
Feminino
Seres Humanos
Angiografia por Ressonância Magnética
Bulbo
Procedimentos Neurocirúrgicos
Siringomielia/complicações
Insuficiência Vertebrobasilar/diagnóstico por imagem
Insuficiência Vertebrobasilar/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170607
[St] Status:MEDLINE



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