1/63. Inferior division third nerve paresis from an orbital dural arteriovenous malformation.Isolated inferior division third nerve palsies are rare. The authors report a patient with an isolated, pupil-involving inferior division third cranial nerve palsy from an intraorbital dural arteriovenous malformation. Despite spontaneous thrombosis of the malformation, the third nerve palsy persisted. To the authors' knowledge, this is the first case report of an inferior division third nerve palsy caused by an orbital dural arteriovenous malformation.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/63. Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report.BACKGROUND: Spinal arteriovenous malformation (SAVM) is a relatively rare disease characterized by a high incidence of intramedullary and subarachnoid haemorrhage. When the hemorrhage is profuse and the SAVM is in the cervical region the symptoms (disturbance of consciousness, papilledema, cranial nerve palsies, and convulsions) may be so severe and rapid in their onset that they may be mistaken for intracranial hemorrhage. We report here on a patient with a SAVM at T10-12, which bled intracranially, mainly intraventricularly, and resulted first in respiratory arrest and unconsciousness. CASE DESCRIPTION: The patient had been well until he was 28 years old when, during intercourse, he suffered a terrible headache and suddenly lost consciousness, with a transient respiratory arrest. He was also noted to have right hemiparesis. A computed tomography scan demonstrated intraventricular hemorrhage. After a 24-hour period of artificial ventilation the patient regained consciousness and the right arm paresis completely recovered, but a gradual worsening of the motor function of the left leg developed. Digital subtraction angiography did not demonstrate any intracranial source of bleeding, whereas spinal angiography revealed a SAVM located at the medullary cone, which was totally removed by surgery. CONCLUSION: The case reported here raises several important issues. First, the advisability of spinal magnetic resonance imaging in the investigation of intraventricular (and subarachnoid) hemorrhage in patients with no demonstrable intracranial source. Secondly, the benefits of early diagnosis and reestablishment of the spinal cord circulation before the onset of thrombosis and the progressive phase of myelopathy. Finally, the necessity of complete obliteration and treatment of SAVMs even in patients with fixed neurologic deficits, because rebleeding of lower thoracic or lumbar SAVMs can lead to impairment at a higher level with severe or lethal consequences.- - - - - - - - - - ranking = 0.125keywords = nerve (Clic here for more details about this article) |
3/63. A detailed histologic analysis of pulmonary arteriovenous malformations in children with cyanotic congenital heart disease.INTRODUCTION: Pulmonary arteriovenous malformations are a common cause of progressive cyanosis in children after cavopulmonary anastomoses. We analyzed the pulmonary histologic characteristics from children in whom pulmonary arteriovenous malformations developed after procedures that resulted in pulmonary arterial blood flow devoid of hepatic venous effluent. methods: We performed routine histologic studies, immunohistochemical staining, and electron microscopic analysis of peripheral lung biopsy specimens from 2 children with angiographically proven pulmonary arteriovenous malformations. Microvessel density was determined with a computer-assisted, morphometric analysis system. RESULTS: Histologic examination demonstrated large, dilated blood vessels ("lakes") and clustered, smaller vessels ("chains") in the pulmonary parenchyma. Microvessel density was significantly greater in these patients than in age-matched controls (P =.01). immunohistochemistry demonstrated uniform staining for type IV collagen and alpha-smooth muscle actin, weak staining for the endothelial marker CD31 (cluster of differentiation, PECAM-1), and negative staining for proliferating cell nuclear antigen. Electron microscopy revealed endothelial irregularity, a disorganized basement membrane, and increased numbers of collagen and actin filaments beneath the endothelium. CONCLUSIONS: This study represents an attempt to characterize the histologic features of pulmonary arteriovenous malformations in children with congenital heart disease who have pulmonary arterial blood flow devoid of hepatic venous effluent. The histologic correlate of this condition appears to be greatly increased numbers of thin-walled vessels. immunohistochemistry suggests that the rate of cellular proliferation is not increased in these lesions. The development of these techniques may provide a standardized histologic approach for this condition and aid in understanding its etiology.- - - - - - - - - - ranking = 0.019086310994986keywords = organ (Clic here for more details about this article) |
4/63. The double-crush phenomenon--an unusual presentation and literature review.The double-crush syndrome was initially described by Upton and McComas in 1973. They postulated that nonsymptomatic impairment of axoplasmic flow at more than one site along a nerve might summate to cause a symptomatic neuropathy. This was suggested by their clinical observation that the majority of their patients had a median or ulnar neuropathy associated with evidence of cervicothoracic root lesions. They also hypothesized that one of the constraints on axoplasmic flow could be a metabolic neuropathy, and this is supported by the high association of diabetes and carpal tunnel syndrome. Other researchers have since reported series of patients supporting the frequent association of a proximal and distal nerve compression syndrome, including carpal tunnel syndrome associated with cervical radiculopathy, brachial plexus compression, and diabetic neuropathy. Subsequently, MacKinnon and Dellon have expanded the description of this syndrome to include a) multiple anatomic regions along a peripheral nerve, b) multiple anatomic structures across a peripheral nerve within an anatomic region, c) superimposed on a neuropathy, and d) combinations of the above. We present an unusual case of symptomatic nerve compression caused by two nonanatomic structures within an anatomic region.- - - - - - - - - - ranking = 0.625keywords = nerve (Clic here for more details about this article) |
5/63. Rare complication of massive hemorrhage in neurofibromatosis with arteriovenous malformation.Neurofibromatosis is rare in the general population. Its clinical manifestations are systemic and variable. The clinical presentation of cutaneous lesions is even more variable. Some patients have giant tumors in the trunk or limbs (so-called "elephant neurofibromatosis"). The pathological findings are diffuse neurofibromatosis of the nerve trunk associated with overgrowth of subcutaneous tissue and skin. The associated vascular malformations make most surgeons hesitant to address them because bleeding to death is possible if the bleeding is not well controlled. According to the authors' experience in treating this complication of neurofibromatosis, they noted that there are three key points to reducing the amount of hemorrhage to a minimal level: (1) hypotensive anesthesia, (2) preliminary sutures around the lesion, (3) ligation of the limited numbers of feeding vessels in the vascular malformation of the neurofibroma. Ligating these pedicles can decrease bleeding during resection of the neurofibroma, as demonstrated in their patient.- - - - - - - - - - ranking = 0.125keywords = nerve (Clic here for more details about this article) |
6/63. Large-cell calcifying Sertoli cell tumour of the testis: associated organ anomalies.A case is reported of unilateral, focal large-cell calcifying Sertoli cell tumour (LCCSCT) of the testis associated with complex endocrine disorders and cardiac myxomas. It is believed that there are two distinct groups of patients with this tumour: those who have complex dysplastic syndromes and bilateral and multifocal tumours; and those without any syndromes but who have unilateral and focal tumours. The presented case differs in that, although the patient has a unilateral focal tumour, unique organ anomalies, such as renal agenesis and inferior vena cava duplication, are also present. These anomalies with LCCSCT have not been reported before.- - - - - - - - - - ranking = 0.095431554974931keywords = organ (Clic here for more details about this article) |
7/63. Renal arteriovenous malformation with thrombus in the inferior vena cava.BACKGROUND: Thrombus formation in the inferior vena cava (IVC) is usually seen in cases with malignancy. In contrast, vascular anomalies hardly ever accompany this disorder. Herein, a case of thrombus formation in the IVC associated with renal arteriovenous malformation (AVM) is reported. methods/RESULTS: A 50-year-old woman who received transarterial embolization (TAE) for AVM in the right kidney noticed right flank pain with macrohematuria 12 months later. Because radiographic evaluation could not rule out malignancy in the kidney, nephrectomy was performed. During nephrectomy, a palpable thrombus was found in the IVC, so thrombectomy was performed simultaneously. Histopathologic examination revealed an old infarction due to the TAE, circumferential arteriovenous thrombi and a large organized thrombus up to the IVC, but neither renal cell carcinoma nor transitional carcinoma in the kidney. CONCLUSIONS: Careful observation may be required, even after treatment for renal AVM, such as TAE, to avoid the formation of an IVC thrombus.- - - - - - - - - - ranking = 0.019086310994986keywords = organ (Clic here for more details about this article) |
8/63. Arteriovenous malformation of a persistent median artery with a bifurcated median nerve.A patient with arteriovenous malformations of the volar forearm and hand arising from a persistent median artery with an associated bifid median nerve is presented. Surgeons should be aware of high median nerve bifurcations, particularly when a persistent median artery is identified, and should remember that additional structures that can lead to nerve compression may be present in the carpal tunnel. Specifically, more than one median nerve may need to be identified and protected in such cases.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/63. Management of pancreatic arteriovenous malformation.Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage.- - - - - - - - - - ranking = 0.019086310994986keywords = organ (Clic here for more details about this article) |
10/63. Goldenhar's syndrome associated with cardiac malformations.A case of Goldenhar's syndrome associated with cardiac malformations such as single ventricle, atresia of pulmonary artery, and patent ductus arteriosus is described. The association of cardiac malformations with Goldenhar's syndrome is very rare and suggests that it is necessary to perform a careful clinical evaluation in this syndrome whether or not additional malformations may exist in visceral organs.- - - - - - - - - - ranking = 0.019086310994986keywords = organ (Clic here for more details about this article) |
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