Lucía Mercedes Niño-Hernández

Non-aneurysmal subarachnoid hemorrhage as presentation of moyamoya disease in an adult

Background: The presentation of moyamoya disease (MMD) as an aneurysmal subarachnoid hemorrhage (SAH) is relatively frequent and in the absence of aneurysms is extremely rare. Case Description: A 53-year-old male patient suddenly developed severe headache associated with dysarthria and an altered state of consciousness. At the time of admission, he was found drowsy with global aphasia, stiff neck, right hemiparesis and right Babinskis sign. A non-contrast brain computed tomography was performed and a small bleeding in the subarachnoid space over the left frontal and parietal cortex was observed. Four-vessel cerebral angiography showed bilateral stenosis of the internal carotid arteries, with multiple tortuous vessels branching from the anterior and middle cerebral arteries. These abnormal vessels were anastomosing with branches from the posterior cerebral and middle meningeal arteries. With this information, a diagnosis of MMD was made. A three-dimensional reconstruction from digital angiography ruled out aneurysms or vascular malformations. After 4 weeks, another angiography was performed and remained the same as previous one. Conclusion: Clinical and radiological characteristics of this case are consistent with previous reports, supporting the theory that non-aneurysmal SAH in MMD is caused by rupture of fragile moyamoya vessels.

Meningioma de células claras intra-espinal: Presentación de un caso y revisión de la literatura

Resumen El meningioma de celulas claras es una variedad rara de meningioma, que se presenta con particular frecuencia a nivel del angulo ponto-cerebeloso y el canal raquideo. Se describe un caso de un paciente femenino de 28 anos de edad con un sindrome de cauda equina completo. La resonancia magnetica nuclear de columna lumbo-sacra revelo una lesion tumoral que ocupa el canal raquideo desde L3 a S1. Se realizo una reseccion subtotal cuyo examen histopatologico revelo un meningioma de celulas claras. Fue indicada radioterapia complementaria, sin embargo, se descubrio que la paciente estaba embarazada, por lo que debio ser pospuesta La recidiva fue clinicamente evidente a los siete meses, requiriendo nueva reseccion y radioterapia complementaria. Se realizo una revision sistematica de la literatura, exponiendose el comportamiento del meningioma de celulas claras dentro del canal espinal.

Metástasis dural como manifestación inicial de cáncer de próstata

Metastases of prostate cancer to intracranial meninges are rare and often confused with meningiomas or chronic subdural hematomas. These usually occur in patients with a known cancer diagnosis in advanced stages of the disease, and only in some rare cases do its manifestations precede the detection of the primary tumour. The clinical presentation is unspecific. However, due to the affinity of this tumour for the base of the skull, it must be included in the differential diagnosis of men over 70 years of age with cranial nerve palsy. The treatment of these lesions has not been standardized. Within the therapeutic options we find surgical resection, chemotherapy, radiotherapy or a combination of these measures, and yet survival is poor. We present the case of a 77 year old male patient whose initial symptoms of prostate cancer were caused by a metastatic lesion to the dura, confirmed by histopathology. We also review the epidemiological, clinical and imaging highlights of this condition.