Marc Laureys

Percutaneous Treatment of Iatrogenic Iliocaval Fistula Related to Endograft Placement for Abdominal Aortic Aneurysm

The authors report a case of iatrogenic dissection occurring during endovascular treatment of an abdominal aortic aneurysm. The dissection was related to catheterization maneuvers that led to the development of a symptomatic arteriovenous fistula, which was successfully closed by coil embolization.

Case report: cerebral vein thrombosis after subarachnoid analgesia for labour.

PurposeWe report a case of sagittal sinus thrombosis occurring after spinal analgesia for labour to highlight the difficulty of such diagnosis in the presence of postpartum atypical headache following regional anesthesia/analgesia.Clinical featuresA previously healthy 21 -yr-old, primiparous, preeclamptic parturient was admitted to the hospital at 37 weeks gestation for uterine contractions. Before pregnancy she was taking no medication other than oral contraceptives and was a non-smoker. Spinal analgesia was established on the first attempt at 8 cm of cervical dilation, in the setting of rapid progression of labour. Following an uneventful delivery, on the third day postpartum, the patient experienced gradual onset of an atypical headache with unclear postural character, followed by focal neurological signs five days later. Emergency neuroimaging revealed direct evidence of thrombosis in the posterior sagittal venous sinus. Anticoagulation was initiated with iv heparin (500 UI·kg-1·day-1). The patient’s headache decreased progressively and full motor recovery was noted by day 14 postpartum. After 24 days, the patient was discharged without any neurological disability. Common inherited thrombophilic dispositions were absent, with the exception of a decrease in protein S level.ConclusionCentral venous thrombosis, while rare, is a recognized cause of puerperium stroke. The present case highlights the importance of considering the diagnosis in the presence of postpartum atypical headache following spinal anesthesia/analgesia. Early intervention with systemic heparinization is critical when the diagnosis is confirmed.RésuméObjectifPrésenter un cas de thrombose du sinus longitudinal, survenue après une rachianalgésie de fin de travail obstétrical, pour illustrer la difficulté d’établir ce diagnostic en présence de céphalées atypiques du postpartum.Éléments cliniquesUne parturiente primipare de 21 ans, prééclamptique, antérieurement en bonne santé, est admise à l’hôpital à 37 semaines de grossesse pour contractions utérines. Avant la grossesse, elle prenait des contraceptifs oraux et ne fumait pas. La rachianalgésie est réalisée sans difficulté au premier essai, au moment où la dilatation cervicale est de 8 cm et le travail en progression rapide. Après un accouchement sans incident, au troisième jour du postpartum, la patiente présente des céphalées atypiques d’apparition graduelle à caractère postural mal défini, suivies de signes neurologiques focaux cinq jours plus tard. Un scanner cérébral et une résonance magnétique en urgence révèlent une thrombose du sinus veineux longitudinal postérieur. L’anticoagulation par héparine iv (500 UI·kg-1·jour-1) est instaurée. Les céphalées diminuent progressivement et la récupération motrice complète est établie au 14e jour du postpartum. La patiente quitte l’hôpital après 24 jours sans séquelles neurologiques. Le bilan de thrombophilie héréditaire s’est avéré négatif, à l’exception d’une baisse du niveau de protéine S.ConclusionLa thrombose veineuse centrale, bien que rare, est une cause connue d’accident vasculaire puerpéral. Il est important de tenir compte du diagnostic en présence de céphalées atypiques du postpartum après une anesthésie/analgésie rachidi-enne. L’intervention précoce par une héparinisation complète est cruciale pour la confirmation du diagnostic.

Percutaneous transhepatic access for ablation of atypical atrial flutter in complex congenital heart disease.

A 12-year-old boy with complex congenital heart disease presented with symptomatic incessant atrial flutter resistant to antiarrhythmic medication. He had 5 previous surgical interventions for (1) a single left ventricle, (2) D-transposition of the great vessels, and (3) interruption of the aortic arch type C. As a result, he had a complete aorto-bifemoral reconstruction, an atrioseptectomy, and a complete cavopulmonary derivation with fenestration to the right atrium, which was subsequently closed by an Amplatz umbrella device for poor oxygen saturation (with a residual cavo-atrial communication). Due to previous surgical interventions and a thrombosis of the right internal jugular vein, he had no transcutaneous venous access except the left internal jugular vein and the hepatic vein. Percutaneous transhepatic access was obtained using a needle positioned below the right costal margin and guided with ultrasound and contrast visualization of the hepatic vein (Figure 1A and B). A single 3.5 mm externally irrigated-tip ablation catheter (Navistar, Biosense Webster, Diamond Bar,

Contrast echocardiography detecting a rare abnormal venous connection

A 74-year-old female patient with a history of deep venous thrombosis of the left axillary vein, presented with an unexpected relapse of ischaemic stroke. The transoesophageal echocardiography demonstrated normal interatrial septum and pulmonary veins. During contrast infusion using a left arm venous access, we noted a simultaneous opacification of the left and right cavities ( Panel B , …

Images in neurology - latrogenic subdural hematoma.

Sir, We report the first description of iatrogenic subdural hematoma following lumbar puncture (LP) for pachymengitidis in a 66-year-old woman suffering from rheumatoid arthritis (RA) treated with prednisolone 7.5 mg/day and infleximab. The patient presented with acute nonfluent aphasia due to an ischemic stroke, justifying the introduction of dipyridamole 400 mg with acetylsalicylic acid 50 mg/day. Computed tomography (CT) scanning performed to exclude hemorrhage revealed asymptomatic hydrocephalus. Lumbar puncture was normal, but did not improve mobility. Follow-up by monthly recurrent brain CT scans was initiated. Three months later, the patient presented with subacute photophobia and nausea. At this time, cerebral CT scan revealed hydrocephalus associated with meningeal enhancement on contrast injection. To exclude meningitis, LP was performed, but it was normal. No causative agents of the underlying disease could be identified, with the exception of RA. Thereafter, she developed disorientation and sleepiness despite the absence of epileptic discharge on electroencephalography. However, a control CT scan of the brain disclosed a cerebellar subdural hematoma (Fig. 1). The symptoms were not thought to be due to this hematoma, but to encephalitis caused by RA, and after a few days on intravenous prednisolone 1 g/day, the symptoms disappeared. The occurrence of subdural hematoma after LP has been described [1] in hematopoietic stem cell patients, and pachymengitidis is known as a rare complication of RA [2]. However, this is the first case involving both presentations underlying this dramatically underestimated complication of LP, especially in case of meningeal inflammation and anti-platelet aggregation treatments.