We describe a case of candida spondylodiscitis secondary to coronavirus disease (COVID-19).
A 47-year-old man diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) required ...prolonged admission to the intensive care unit (ICU). Four months later, he was diagnosed with thoracic candida spondylodiscitis. Medical management was insufficient, so he eventually underwent surgery.
Fungal infections seem to be more likely in patients with COVID-19, but it is unknown whether they are directly attributed to COVID-19 or other surrounding factors. Regardless of the answer, the diagnosis is complicated, and the mortality rate is high.
COVID-19 is posing a challenge to the society, and new and unexpected diseases that had once disappeared have risen again. It is our duty to suspect them and to treat them in the most effective way possible.
Cerebral convexity arachnoid cysts (ACs) only represent around 10-14% of the cysts. Symptomatic ACs in the elderly are rare. We present a 66-year-old woman with headache and a focal epileptic ...seizure. Imaging revealed a left parietal AC. Conservative management chosen but the patient's neurological condition worsened, and an endoscopic fenestration was then performed. Postoperatively, her symptoms completely resolved and MRI image showed significant shrinkage of the AC.
The authors describe a patient with delayed thoracic spinal cord compression due to fibrous scar tissue around an epidural electrode used in spinal cord stimulation (SCS). One year after implantation ...of the system the stimulation became ineffective, and 1 year later the patient developed progressive paraparesis. There was no evidence of device-related complications on plain radiographs and CT scans, so the system was removed to perform MRI studies. These studies showed a dorsal myelopathy secondary to scar tissue around the electrode. At surgery thick scar tissue was resected, and the patient's neurological symptoms improved. The histological examination confirmed fibrosis, and microbiological studies excluded chronic infection. As far as the authors are aware, this complication has never been reported before at the thoracic level. Scarring around SCS electrodes should be considered as a late complication and as a possible cause of the tolerance phenomenon.
Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF ...and expose the lateral wall of the cavernous sinus and the Meckel's cave.
The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF.
Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw.
LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.
Sleep disorders in traumatic brain injury Paredes, Igor; Navarro, Blanca; Lagares, Alfonso
Neurocirugía (Barcelona. Internet. English ed.),
2020-Nov-11
Journal Article
Recenzirano
The purpose of the review is to collect the most relevant current literature on the mechanisms of normal sleep and sleep disorders associated with traumatic brain injury (TBI), to discuss the most ...frequent conditions and the evidence on their possible treatments and future research. Sleep disorders are extremely prevalent after TBI (30-84%). Insomnia and circadian rhythm disorders are the most frequent disorders among the population that has suffered mild TBI, while hypersomnolence disorders are more frequent in populations that have suffered moderate and severe TBI. The syndrome of obstructive sleep apnea and restless leg syndrome are also very frequent in these patients; and patients exposed to multiple TBIs (war veterans) are especially susceptible to sleep disorders. The treatment of these disorders requires taking into account the particularities of these patients. In conclusion, diagnosis and treatment of sleep disorders should become part of routine clinical practice and cease to be anecdotal (as it is today) in patients with TBI. In addition, it is necessary to continue carrying out research that reveals the best therapeutic approach to these patients.
Sleep disorders in traumatic brain injury Paredes, Igor; Navarro, Blanca; Lagares, Alfonso
Neurocirugía (Barcelona. Internet. English ed.),
July-August 2021, 2021-07-00, 20210701, Letnik:
32, Številka:
4
Journal Article
Recenzirano
The purpose of the review is to collect the most relevant current literature on the mechanisms of normal sleep and sleep disorders associated with traumatic brain injury (TBI), to discuss the most ...frequent conditions and the evidence on their possible treatments and future research.
Sleep disorders are extremely prevalent after TBI (30-84%). Insomnia and circadian rhythm disorders are the most frequent disorders among the population that has suffered mild TBI, while hypersomnolence disorders are more frequent in populations that have suffered moderate and severe TBI. The syndrome of obstructive sleep apnea and restless leg syndrome are also very frequent in these patients; and patients exposed to multiple TBIs (war veterans) are especially susceptible to sleep disorders. The treatment of these disorders requires taking into account the particularities of these patients.
In conclusion, diagnosis and treatment of sleep disorders should become part of routine clinical practice and cease to be anecdotal (as it is today) in patients with TBI. In addition, it is necessary to continue carrying out research that reveals the best therapeutic approach to these patients.
El propósito de la revisión es recopilar la literatura actual mas relevante sobre los mecanismos de sueño normal y los trastornos del sueño asociados al traumatismo craneoencefálico (TCE), discutir las afecciones mas frecuentes y la evidencia sobre sus posibles tratamientos y futuras investigaciones.
Los trastornos del sueño son extremadamente prevalentes tras un TCE (30-84%). El insomnio y los trastornos del ritmo circadiano son los trastornos mas frecuentes entre la población que ha sufrido TCE leve, mientras que los trastornos por hipersomnia son mas frecuentes en poblaciones que han sufrido TCE moderado y grave. El síndrome de apneas obstructivas del sueño y el síndrome de piernas inquietas son también muy frecuentes en estos pacientes; y los pacientes expuestos a múltiples TCEs (veteranos de guerra) son especialmente susceptibles a sufrir trastornos del sueño. El tratamiento de estos trastornos requiere tener en cuenta las particularidades de estos pacientes.
Como conclusión, el diagnóstico y tratamiento de los trastornos del sueño debería convertirse en parte de la práctica clínica habitual, y dejar de ser anecdótico (como es hoy en día) en pacientes con TCE. Además, es necesario continuar realizando investigación que nos revele cuál es la mejor aproximación terapéutica a estos pacientes.
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