scholarly journals Progressive Neurological Decline with Deep Bilateral Imaging Changes: A Protean Presentation of Dural Arteriovenous Fistulae

2018 ◽  
Vol 7 (5) ◽  
pp. 256-264
Author(s):  
Rene A. Colorado ◽  
Marcelo Matiello ◽  
Hyun-Sik Yang ◽  
James D. Rabinov ◽  
Aman Patel ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Endovascular Embolization ◽  
Behavioral Changes ◽  
Neoplastic Disease ◽  
High Morbidity ◽  
Cerebral Vasculature ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae ◽  
Variable Clinical Presentation

Intracranial dural arteriovenous fistulae (DAVF) within the deep cerebral vasculature are diagnostically challenging because of their variable clinical presentation and typical bilateral neuroimaging findings mimicking inflammatory, infectious, and metabolic processes. Increasingly, reports have emerged highlighting the diagnostic and treatment challenges of these lesions and their associated high morbidity and rapid clinical deterioration when untreated. We describe here a case series of 4 patients with deep cerebral DAVF who presented with impaired arousal or memory and behavioral changes. In all patients, the initial differential diagnosis included metabolic, inflammatory, infectious, or neoplastic disease, with an eventual correct diagnosis obtained after catheter angiography had demonstrated arterialization of the deep venous structures, including the vein of Galen. All patients were successfully treated with endovascular embolization, with 1 patient requiring additional surgical treatment. We review the contemporary diagnostic evaluation and management of DAVF within the deep cerebral vasculature. With rapid diagnosis and treatment, a favorable outcome is possible.

scholarly journals Mycotic (Infected) Pseudoaneurysm, a Diagnostic Challenge – Case Series

2020 ◽  
Vol 10 ◽  
pp. 86
Author(s):  
Praveen K Sharma ◽  
Sai Sindhura Garisa ◽  
S. Vinod Kumaran ◽  
Sparsh Varma
Keyword(s):  
Arterial Wall ◽  
Imaging Modality ◽  
Case Series ◽  
Endovascular Embolization ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Tissue Mass ◽  
Mycotic Pseudoaneurysm ◽  
Arterial Lumen ◽  
Infected Pseudoaneurysm

Mycotic pseudoaneurysm (or infected pseudoaneurysm) is an infectious arteritis, leading to the destruction of the arterial wall with the formation of a blind, saccular outpouching contiguous with the arterial lumen. Delayed management or non-management of mycotic pseudoaneurysms is associated with high morbidity and mortality due to complications such as arterial rupture, hemorrhage, and fulminant sepsis. Earlier diagnosis of mycotic pseudoaneurysm is essential for time management. Multidetector computed tomography (MDCT) is a widely used imaging modality for detecting the mycotic pseudoaneurysm, its characterization, and vascular mapping. MDCT findings of mycotic pseudoaneurysm are blind, saccular outpouching of an artery with irregular arterial wall, perivascular soft-tissue mass, or edema. Uncommon results of MDCT include arterial lumen thrombosis, arterial wall calcification, and perivascular gas. Management of mycotic pseudoaneurysm includes endovascular stenting with graft repair, endovascular embolization, open surgery, medical therapy (intravenous antibiotics), or a combination of these. We report three cases of mycotic pseudoaneurysm affecting aortic isthmus, a segmental branch of the pulmonary artery, and the internal mammary artery. All cases posed a diagnostic challenge, which only on subsequent imaging revealed to be a mycotic pseudoaneurysm.

scholarly journals A case series of intracranial dural arteriovenous fistulae mimicking cervical myelitis: a diagnosis not to be missed

2021 ◽  
Author(s):  
Daniel Whittam ◽  
Saif Huda ◽  
Emily Gibbons ◽  
Richard Pullicino ◽  
Tom Solomon ◽  
...  
Keyword(s):  
Case Series ◽  
Cervical Cord ◽  
Retrospective Case ◽  
Diagnostic Features ◽  
Arteriovenous Fistulae ◽  
Exact Test ◽  
Life Threatening ◽  
Mri Sequences ◽  
Male Patients ◽  
Intracranial Dural Arteriovenous Fistulae

Abstract Objective To describe the diagnostic features of intracranial dural arteriovenous fistulae (DAVF) presenting with cervical cord or brainstem swelling. Methods Retrospective case note and neuroimaging review of patients with angiographically confirmed DAVF diagnosed during January 2015–June 2020 at a tertiary neuroscience centre (Walton Centre NHS Foundation Trust, Liverpool, UK). Results Six intracranial DAVF causing cervical cord or brainstem oedema (all males aged 60–69 years) and 27 spinal DAVF (88% thoracolumbar) were detected over a 5.5-year period. Significantly more patients with intracranial DAVF received steroids for presumed inflammatory myelitis than those with spinal DAVF (5/6 vs 1/27, p = 0.0001, Fisher’s exact test). Several factors misled the treating clinicians: atypical rostral location of cord oedema (6/6); acute clinical deterioration (4/6); absence (3/6) or failure to recognise (3/6) subtle dilated perimedullary veins on MRI; intramedullary gadolinium enhancement (2/6); and elevated CSF protein (4/5). Acute deterioration followed steroid treatment in 4/5 patients. The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). Conclusion Intracranial DAVF are uncommon but often misdiagnosed and treated as myelitis, which can cause life-threatening deterioration. Neurologists must recognise suggestive features and consider angiography, especially in older male patients. Dilated perimedullary veins are an important clue to underlying DAVF, but may be invisible or easily missed on routine MRI sequences.

Microsurgical Findings of Pial Arterial Feeders in Intracranial Dural Arteriovenous Fistulae: A Case Series

2020 ◽  
Author(s):  
Michinari Okamoto ◽  
Taku Sugiyama ◽  
Naoki Nakayama ◽  
Satoshi Ushikoshi ◽  
Ken Kazumata ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Case Series ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Cortical Venous Drainage ◽  
Intracranial Dural Arteriovenous Fistulae ◽  
System 1

Abstract BACKGROUND Pial arterial feeders in an intracranial dural arteriovenous fistula (dAVF) are risk factors for both ischemic and hemorrhagic complications during endovascular embolization. Microsurgery in dAVF with pial arterial feeders has rarely been reported. OBJECTIVE To assess our original experience with microsurgery for dAVF with pial arterial feeders by investigating surgical findings and outcomes. METHODS In 40 patients with intracranial dAVF who underwent microsurgery, we found 8 patients who had pial arterial feeders. A retrospective review was conducted. RESULTS The locations of the dAVFs were as follows: tentorium, 2 patients; Galenic system, 1; straight sinus, 1; torcula, 1; transverse sinus, 1; ethmoid, 1; and convexity, 1. Preoperative angiography revealed that the pial arterial feeders originated from the middle cerebral artery in 2 patients, the anterior cerebral artery in 1, the posterior cerebral artery in 2, and the posterior medial choroidal artery in 1. Of note, in 2 patients (6.7%), feeders from the superior cerebellar artery were determined to be angiographically occult during preoperative examination and were detected through careful intraoperative observation and arachnoid dissection. In 5 cases, the additional obliteration of the pial arterial feeders and/or more distal cortical venous drainers after the simple disconnection of proximal cortical drainers was necessary to cure the dAVF. Finally, all shunts were cured with only 1 minor complication. CONCLUSION Although microsurgical results were acceptable, the surgeon should be aware of the presence of pial arterial feeders even after the simple disconnection of cortical venous drainage. Angiographically occult feeders may also exist.

How endoscopic ultrasound (eus) was decisive to establish the correct diagnosis of patients – a case series

2019 ◽  
Author(s):  
M Razpotnik ◽  
S Bota ◽  
G Essler ◽  
J Weber-Eibel ◽  
M Peck-Radosavljevic
Keyword(s):  
Endoscopic Ultrasound ◽  
Correct Diagnosis ◽  
Case Series

Aumento de coroa estética sem elevação de retalho – abordagem minimamente invasiva

2020 ◽  
Vol 12 (45) ◽  
pp. 34-39
Author(s):  
Flavia Sukekava ◽  
Julia Helena Luiz ◽  
Paloma Palma ◽  
Jaques Luiz
Keyword(s):  
Minimally Invasive ◽  
Correct Diagnosis ◽  
Case Series ◽  
Minimally Invasive Techniques ◽  
Bone Removal ◽  
Use Of Technology ◽  
Treatment Plans ◽  
Invasive Techniques ◽  
Crown Lengthening ◽  
Gummy Smile

Gummy smile is a characteristic in which the patient exposes more than 2 mm of keratinized gingiva in forced smile. With a multifactorial cause, its correct planning depends directly on the correct diagnosis. Usually, the procedures that involve manipulation and the enlargement of the aesthetical crown lengthening are surgical. The objective of this case series was to show the advantages of surgical crown augmentation surgery in aesthetic areas with minimally invasive techniques. Three cases of gummy smile were presented, with different treatment plans and techniques for execution. In the 3 cases, bone removal was performed with piezoelectric ultrasound, which made the postoperative more comfortable for patients. These cases illustrate the use of technology to reduce morbidity in patients who need to undergo bone removal to treat gingival smile.

Transition to Ductal Stenting for Single Ventricle Patients Led to Improved Survival: An Institutional Case Series

2021 ◽  
Vol 12 (4) ◽  
pp. 518-526 ◽  
Author(s):  
Neel K. Prabhu ◽  
Alexander Zhu ◽  
James M. Meza ◽  
Kevin D. Hill ◽  
Gregory A. Fleming ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Case Series ◽  
Stage Ii ◽  
Shunt Revision ◽  
High Morbidity ◽  
Mechanical Ventilation Duration ◽  
Hospital Morbidity

Background: The use of systemic-to-pulmonary shunts (SPS) in neonates with single ventricle heart defects and ductal-dependent pulmonary blood flow (ddPBF) was historically associated with high morbidity and mortality at our center. As a result, we transitioned to the preferential use of ductus arteriosus stents (DS) when feasible. This report describes our initial results with this strategy. Methods: A single-center study of single ventricle patients that received DS or SPS from 2015 to 2019 was performed to assess whether DS was associated with decreased in-hospital morbidity and increased survival to stage II palliation. Results: A total of 34 patients were included (DS = 11; SPS = 23). Underlying cardiac anomalies were similar between groups and included pulmonary atresia, unbalanced atrioventricular septal defect, and tricuspid atresia. Procedure success was similar between groups (82% vs 83%). Two DS patients were converted to SPS, due to ductal vasospasm or pulmonary artery obstruction, and four SPS patients required surgical shunt revision. In DS patients, postprocedure mechanical ventilation duration was shorter (one vs three days, P = .009) and fewer required postprocedure extracorporeal membrane oxygenation (9% vs 39%, P = .11). A higher proportion of DS patients survived to stage II palliation (100% vs 64%, P = .035), and the probability of one-year survival was higher in DS patients (100% vs 61%, P = .02). Conclusions: At our center, patients with single ventricle heart defects and ddPBF that received DS experienced reduced in-hospital morbidity and increased survival to stage II palliation compared to SPS.

scholarly journals Toxoplasma encephalitis presenting as neoplastic disease: A single institution case series

2021 ◽  
Vol 25 ◽  
pp. 101174
Author(s):  
Jennifer L. Perez ◽  
Zachary C. Gersey ◽  
Daniel F. Marker ◽  
Georgios A. Zenonos ◽  
Pascal O. Zinn
Keyword(s):  
Case Series ◽  
Neoplastic Disease ◽  
Single Institution ◽  
Toxoplasma Encephalitis

The Role of Visceral Transplantation for Neoplastic Disease

2020 ◽  
Vol 04 (03) ◽  
pp. 273-281
Author(s):  
Masato Fujiki ◽  
Amit Nair ◽  
Giuseppe D'amico ◽  
Mohammed Osman
Keyword(s):  
Patient Survival ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Case Series ◽  
National Database ◽  
Neuroendocrine Neoplasms ◽  
Neoplastic Disease ◽  
Desmoid Tumors ◽  
Post Transplant ◽  
Recipient Tissue

AbstractVisceral transplantation has been utilized as the most radical surgical treatment for neoplasms not amenable to conventional resection. The main indications for this procedure include mesenteric desmoid tumors threatening the root of mesentery and metastatic neuroendocrine neoplasms. Published case-series of visceral transplantation for such indications are reviewed in this article. Patients with desmoid tumors associated with familial adenomatous polyposis are transplanted with intestinal or multivisceral allografts. With surgical modification of technique, the native spleen is preserved while duodenopancreatic complex is removed to obviate the risk of malignant transformation of duodenal polyposis after transplantation. Preservation of spleen decreased incidence of post-transplant lymphoproliferative disorder, conferring therapeutic advantage. Patient survival is comparable to that of other indications, and desmoid tumor recurrence has been observed in the recipient tissue but not in the donor allograft. For visceral transplantation of metastatic neuroendocrine neoplasms, the majority of these patients have diffuse liver involvement, thus requiring full multivisceral transplantation. Post-transplant patient survival is acceptable with limited data available on recurrence. Autotransplantation following ex vivo tumor resection using visceral allografts has been also performed in a limited, select cohort of patients with various pathologies. Adenocarcinomas are associated with a prohibitive recurrence rate following the procedure, and its use for this indication is therefore not recommended. A national database of visceral transplantation undertaken for neoplastic disease should be developed to better understand predictors of outcomes and to help produce and standardize selection criteria.

scholarly journals Pulmonary arteriovenous malformation (PAVM) embolization: prediction of angiographically-confirmed recanalization according to PAVM Diameter changes on CT

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jihoon Hong ◽  
Sang Yub Lee ◽  
Jung Guen Cha ◽  
Jae-Kwang Lim ◽  
Jongmin Park ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Endovascular Embolization ◽  
Pulmonary Arteriovenous Malformation ◽  
Conventional Angiography ◽  
Receiver Operating Characteristic Curves ◽  
Vein Diameter ◽  
Diameter Reduction

Abstract Background To assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on PAVM diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard. Methods A retrospective review was done of patients from 2008 to 2019 with a PAVM treated with endovascular embolization. The treatment outcome was determined by conventional angiography. Follow-up pulmonary angiography was performed when recanalization was suspected on CT, or embolization of all lesions in multiple PAVM patients could not be completed in a single session. Patients who had no preprocedural or follow-up CT were excluded. Draining vein, feeding artery, and venous sac diameter were measured on CT, and diameter reduction rates were compared with the widely-used, binary 70 % criteria. Results Forty-one patients with 114 PAVMs were treated during the study period. Eight patients with 50 PAVMs met the inclusion criteria. Mean vein, artery, and venous sac diameter reduction rates were as follows: 59.2 ± 9.3 %, 47.5 ± 10.6 %, and 62.6 ± 13.2 %, respectively, in the occluded group and 5.4 ± 19.5 %, 11.3 ± 17.7 %, and 26.8 ± 14.2 %, respectively, in the recanalized group. The area under the receiver operating characteristic curves for PAVM recanalization for the draining vein was 1.00, showing a better result than the artery (0.97) and sac (0.99). Patients showed > 42 % draining vein diameter reduction in the occluded group and < 32 % in the recanalized group. The widely-used 70 % criteria showed low specificity for predicting recanalization (draining vein, 7.3 %; venous sac, 41.7 %) but 100 % sensitivity for both the draining vein and venous sac. Conclusions The widely-used 70 % binary criteria showed limited performance in predicting outcomes in this angiographically-confirmed case series. Further investigations are warranted to establish a strategy for detecting recanalization after PAVM embolization.

Sign in / Sign up

Export Citation Format

Share Document