Casos interesantes/Interesting cases

http://www.smo.edu.mx/jornada2013/






Ceguera postcarniectomía en posición supina: ¿Improbable o ignorada?


Post-craniotomy blindness in the supine position: Unlikely or ignored?.
Vahedi P, Meshkini A, Mohajernezhadfard Z, Tubbs R S.
Asian J Neurosurg [serial online] 2013 [cited 2013 Apr 8];8:36-41.



Immediate visual loss following craniotomy in the supine position is a disastrous complication in neurosurgical patients. The incidence is unknown and little is known on the definite pathogenesis. Also, preventive or restorative interventions are unclear. We describe the rare case of post-craniotomy optic neuropathy and sudden visual loss after craniotomy in the supine position for an olfactory groove meningioma, discuss the possible pathophysiology and review the literature on the pathogenesis, risk factors, and outcome. Although rare, neurosurgeons, as well as neuroanesthesiologists should be aware of the possibility of this devastating complication in the high-risk group of patients.
Keywords: Craniotomy, ischemic optic neuropathy, papilledema, pathophysiology, visual loss
http://www.asianjns.org/text.asp?2013/8/1/36/110278

Bloqueo del nervio popliteo guiado con ultrasonido en un paciente con degeneración maligna de neurofibromatosis 1
Ultrasound-guided popliteal nerve block in a patient with malignant degeneration of neurofibromatosis 1.
Desai A, Carvalho B, Hansen J, Hill J.
Department of Anesthesia, H3580, Stanford University School of Medicine, Stanford, CA 94305, USA.
Case Rep Anesthesiol. 2012;2012:753769. doi: 10.1155/2012/753769. Epub 2012 May 9.
Abstract
A 41-year-old female patient with neurofibromatosis 1 presented with new neurologic deficits secondary to malignant degeneration of a tibial lesion. Ultrasound mapping of the popliteal nerve revealed changes consistent with an intraneural neurofibroma. Successful popliteal nerve blockade was achieved under ultrasound guidance.
http://www.hindawi.com/crim/anesthesiology/2012/753769/



Lo más raro de lo raro
Rarer in a Rare.
Taksande B, Patil M M, Banode P, Deshpande R.
Ann Med Health Sci Res [serial online] 2013 [cited 2013 Mar 25];3:125-6.
Though moya moya disease is a disease of Asian origin, it is one of the very rare causes of stroke in India. It is a rare disease mainly characterized by progressive cerebrovascular episode due to the slowly progressive stenosis of supraclinoid segment of bilateral internal carotid arteries, the anterior and the middle cerebral arteries, and very rarely, posterior cerebral arteries. We hereby report a case of a young female who presented to us with the psychiatric complaints and refractory headache since her childhood. Therefore, we are reporting rarer (headache and neuropsychiatric) manifestations in the rare (moya moya) disease.
Keywords: Headache, Moya moya, Neuropsychiatry, Stroke
http://www.amhsr.org/text.asp?2013/3/1/125/109482


Afonía inducida por infartos bilaterales simultáneos de núcleo putamen: informe de caso y revisión de la literatura

Aphonia induced by simultaneous bilateral ischemic infarctions of the putamen nuclei: a case report and review of the literature
Vladimir V Senatorov1, Shirish Satpute1, Katherine Perry2, David M Kaylie3 and John W Cole
Journal of Medical Case Reports 2013, 7:83
Introduction
Isolated aphonia induced by acute stroke is a rare phenomenon with only a few cases reported in the literature. Case presentation. We report an unusual case of a 44-year-old African-American man with a history of hypertension, smoking and cocaine use who developed acute aphonia secondary to simultaneous ischemic infarctions of the bilateral putamen nuclei. Conclusion. We describe the clinical presentation of acute aphonia induced by bilateral putamen nuclei ischemic infarctions, correlating clinical symptoms with injury localization. We further highlight the anatomic and functional organization of the neural pathways involved.
http://www.jmedicalcasereports.com/content/pdf/1752-1947-7-83.pdf



Bloqueo del nervio frénico guiado con ultrasonido para el tratamiento del hipo: informe de caso

Phrenic nerve block with ultrasound-guidance for treatment of hiccups: a case report.
Kuusniemi K, Pyylampi V.
Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, Luolavuorentie 2, Turku 20700, FI-20520, Finland. kristiina.kuusniemi@tyks.fi.
J Med Case Rep. 2011 Oct 3;5:493. doi: 10.1186/1752-1947-5-493.
Abstract
INTRODUCTION: Persistent hiccups can be more than a simple and short-lived nuisance and therefore sometimes call for serious consideration. Hiccupping episodes that last only a few minutes may be annoying, but persistent hiccups may initiate many major complications.
CASE PRESENTATION: A 72-year-old Caucasian man with spinal stenosis presented for L4-5 laminectomy under spinal anesthesia. The surgery and anesthesia, as well as the perioperative period, passed without any incident, except for persistent postoperative hiccups not responding to conservative and pharmacological treatment. Hiccups resulted in a prolonged hospital stay as they lasted until the seventh postoperative day. On that day, a right-sided ultrasound-guided phrenic nerve block with 5 ml of bupivacaine 5 mg/ml with epinephrine was performed successfully with a single-injection technique. Ten minutes after the procedure the hiccups vanished and a partial sensomotoric block of his right shoulder developed. No adverse effect occurred; our patient could be discharged on the same day and the hiccups did not return. CONCLUSION: Ultrasound provides us with non-invasive information regarding anatomy and allows anesthesiologists to visualize needle insertion, to identify the exact location of the injected solution and to avoid such structures as arteries or veins. As such, this method should be actively utilized. In cases where both pharmacological and non-pharmacological treatments prove to be ineffective when treating persistent hiccups, a single-shot ultrasound-guided technique should be considered before the patient becomes exhausted.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193825/pdf/1752-1947-5-493.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org