A 62-year-old woman presented with severe pain in the distribution of the second and third branches of the left trigeminal nerve. Pain was related to an infarct located in the brainstem at the entry of the trigeminal nerve. As pain was refractary to medical therapy, we performed a selective prepontine trigeminal rhizotomy. The procedure resulted in total relief of pain with preservation of sensation in the distribution of the trigeminal nerve.
Reportes de Casos Clínicos
Rizotomía Prepontina para el Tratamiento de la Neuralgia Trigeminal Secundaria a Infarto de Tronco Cerebral
Palabras clave: nervio trigémino,
Rizotomía Prepontina,
Keywords: prepontine trigeminal rhizotomy,
trigeminal nerve,
Estesioneuroblastoma: Presentación de un Caso y Revisión de la Literatura
A 34-year-old man presente wiith progressive anosmia, epistaxis, and intracranial hypertension related to a nasal tumor with intracranial extension. After surgical resection of the lesion, inmunohistochemical and electrical microscopy study of the biopsy material stablished the diagnosis of esthesioneuroblastoma or olfactory neuroblastoma. This is a rare embrionary tumor derived from neuroblasts of the olfactory sensorial system. That portion of the olfactory tract is located at the upper half of the nostrils, above the cribiform plate. Esthesioneuroblastoma shows a bimodal incidence with a first peak in the second decade, and a second and most important peak during the third and fifth decades of live. Individuals from both sexes are similarly affected. Pollipoid mass with epistaxis or nasal obstruction and chronic anosmia are the most common clinical manifestations of this tumor. It is invasive and frequently causes regional and distant metastasis; however, some tumors could stay without recognition until its intracranial growing through the cribiform plate causes neurologic symptoms.
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Palabras clave: estesioneuroblastoma,
neuroblastoma olfatorio,
Keywords: esthesioneuroblastoma,
olfactory neuroblastoma,
Pseudotumor cerebral: el lado maligno del espectro clínico
Introduction. The pseudotumor cerebri syndrome (PTC) is a clinical entity of unknown etiology affecting mainly young, obese women. The major morbidity factor in this condition is the possibility of vision loss, initially considered to be low, but now known to affect a significant proportion of patients. Clinical case. We describe a case of PTC in a young, obese black women who presented with headache, transient visual blurring and diplopia. Besides obesity, there where no other relevant clinical findings, namely other pathologies and history of medication use. An extensive analytical workup was negative and the CSF showed no abnormalities, aside from increased pressure. Brain MRI was also normal. The clinical course was progressively worse, consisting of rapid vision loss associated with an intracranial pressure of over 850 mmH2 O, despite treatment with diuretics (acetazolamide, furosemide and spironolactone) in therapeutic dosage. Eventually, the patient needed the rapid implantation of a lumboperitoneal shunt to prevent blindness, and went on to make a nearly full recovery. Conclusions. In all major series of PTC, loss of vision has been reported to occur in a significant percentage of patients, and cases have been described in which a catastrophic course with rapid progression to near blindness has led to the introduction of the designation of ‘malignant’ pseudotumor cerebri. We believe that such cases, although rare, need to be recognized as the malignant end of the spectrum of PTC, and that their management constitutes a neurological emergency.
