1/7. Sinusitis and carotid artery stroke.The relationship between sinusitis and ischemic stroke is unexplored. The anatomic proximity between the paranasal sinuses and the internal carotid artery suggests that inflammation of the sinuses could easily extend to the intracranial vasculature. We report 4 patients with acute ischemic stroke and extensive disease of the paranasal sinuses. All patients had large vessel stroke involving the internal carotid artery territory. All patients had extensive disease of the sphenoid and other sinuses. The sinus disease was demonstrated by magnetic resonance imaging. These case report observations suggest a relationship between inflammation of the paranasal sinuses, particularly sphenoid sinusitis, and ischemic stroke.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Traumatic intracranial aneurysms complicating anterior skull base surgery.Traumatic cerebral aneurysm formation following closed head injury is uncommon, although well documented in the literature. Aneurysmal development following surgical procedures on the anterior skull base is extremely rare. This article reports successful neurosurgical management of 3 cases of anterior circulation aneurysms that developed following relatively straightforward rhinological procedures. These cases illustrate the vulnerability of the vessels of the anterior circle of willis; they also document the sites of penetration of the anterior skull base. As reported in the literature, most such aneurysms occur following transsphenoidal surgery. The clinical procedures, radiological follow-up, and the surgical management are outlined; three cases are utilized to illustrate this complication. The causes of such iatrogenic injury are discussed, with emphasis on strategies for the avoidance of such injuries.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. microscopic polyangiitis histologically confirmed by biopsy from nasal cavity and paranasal sinuses: a case report.microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vessels without necrotizing granulomatous inflammation and is commonly associated with necrotizing glomerulonephritis. diagnosis is based on typical clinical features, the presence of antimyeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA), and histopathologic findings. Cases of pathologically proven small-vessel vasculitis in nasal biopsy specimens are sparse. Here we report a patient with MPA that was histopathologically confirmed by nasal and paranasal biopsy. A 67-year-old man presented with fever and general fatigue. Laboratory examinations showed severe inflammation and acute progressive renal failure. The serum MPO-ANCA level was elevated. The patient also had nasal polyps that seemed to be nonspecific chronic sinusitis. To obtain a pathologic diagnosis, bilateral ethmoidectomy and nasal polypectomy were performed. Pathological findings revealed vasculitis of small vessels in the mucosal surface. MPA was diagnosed on the basis of clinical symptoms, elevated MPO-ANCA and the pathological findings of the nasal and paranasal surgical specimen.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/7. Subperiosteal orbital hemorrhage associated with chronic sinusitis: a case report and review of the literature.A case of subperiosteal orbital hemorrhage associated with chronic sinusitis is reported. A 57-year-old woman had a sudden onset of severe orbital pain and exophthalmos in the left eye. Computed tomography revealed a discrete round mass in the left retro-orbital space. An external frontoethmoidectomy was performed to evacuate the hematoma of the subperiosteal space. Additionally, the mucosa was edematous in the left ethmoid sinus. It appears that subperiosteal orbital hemorrhage in this case was caused by rupture of vessels which were inflamed as a result of sinusitis. Orbital hemorrhage associated with chronic sinusitis has rarely been reported. diagnosis and treatment are discussed and etiologic factors are reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. Bilateral acute retinal necrosis.Four patients who experienced the sudden onset of anterior uveitis with large keratic precipitates and dense vitreous opacities developed confluent yellow-white swellings and exudates in the peripheral retina and sheathing and obliteration of retinal arteries. After absorption of the exudates, atrophic patches in the peripheral retina and a funnel-shaped retinal detachment with many tears appeared. Angiograms showed retinal edema, fluorescein leakage from the choroid in the affected areas, and perivasculitis of the retinal arteries. Although treatment seemed unable to alter the course of the disease, in one case the retina reattachment after vitrectomy and filling of the vitreous space with silicone oil. Histopathologic studies disclosed extensive atrophy and degeneration of the outer retinal layers and pigment epithelium and occlusion of the retinal vessels. An infection may trigger the uveitis, leading to an autoimmune sensitization against rods and cones that causes severe local immune-complex disease and retinal vasculitis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. A new classification and diagnostic criteria for invasive fungal sinusitis.OBJECTIVE: To develop criteria for the diagnosis of invasive fungal sinusitis. DESIGN: review of the literature on invasive fungal sinusitis in the context of a population of 30 patients with fungal sinusitis and 24 patients with chronic bacterial sinusitis. SETTING: Tertiary care medical center. RESULTS: Our review revealed no consensus in the literature on the classification of the syndromes of invasive fungal sinusitis and no criteria for their diagnosis. Moreover, the existing syndromes of invasive fungal sinusitis lacked specificity and one of the more commonly cited syndromes, primary aspergillosis of the paranasal sinuses, is a granulomatous disease that occurs rarely outside africa. Two of our 30 patients with fungal sinusitis had a previously unrecognized form of invasive disease. Both were middle-aged adults with well-controlled type 2 diabetes mellitus, apical orbital syndrome, and a similar course: proptosis resulting from fungal expansion out of an ethmoid sinus, a protracted illness of 6 months or longer, visual changes, late neurological symptoms reflecting cavernous sinus invasion, and death. The syndrome in these 2 patients is distinct from the syndrome of fulminant invasive fungal sinusitis, (eg, mucormycosis) with nasal eschar, intracerebral fungal dissemination by vascular invasion, and death in days, and the granulomatous form. CONCLUSIONS: We conclude that there are 3 forms of invasive fungal sinusitis and propose that they be termed (1) granulomatous, (2) acute fulminant, and (3) chronic invasive. The latter category reflects the syndrome seen in our 2 patients. Furthermore, the following 2 diagnostic criteria for invasive fungal sinusitis are proposed: (1) sinusitis confirmed by radiological imaging and (2) histopathological evidence of hyphal forms within sinus mucosa, submucosa, blood vessels, or bone. The specificity of hyphae within sinus mucosa for tissue invasion was supported by the absence of stainable hyphae in the mucosa of patients with chronic bacterial sinusitis or in the mucosa of our described patients with allergic fungal sinusitis and mycetoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Fungal aneurysms of intracranial vessels.Intracranial fungal aneurysms arise from major cerebral arteries. fungi directly invade vessel walls from the luminal surface (fungal emboli) or from the adventitia (fungal meningitis). The vasa vasorum are free of fungi. Aneurysmal rupture is common with extensive hemorrhagic necrosis of the surrounding brain. aspergillus is the usual causative agent; its sources are nasal sinusitis or endocarditis.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |