Anterior approaches to non-traumatic lesions of the thoracic spine.
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Biomedical subjects
Publications and source records attributed to A M Trindade.
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BACKGROUND: Giant distal anterior cerebral artery (ACA) aneurysms are rare lesions, with only 10 cases having been reported in the literature. Their diagnosis may be difficult on computed tomography (CT) scan, often simulating a callosal tumor or hematoma, with only magnetic resonance imaging (MRI) scan or angiography allowing a correct diagnosis. CASE REPORT: The authors present one case of a giant distal ACA aneurysm not visualized on angiography, and whose MRI scan was interpreted as a hemorrhage from a cavernoma or a glioma. The correct diagnosis was only made during surgery, and was confirmed by histopathologic examination. CONCLUSIONS: The authors conclude that distal ACA aneurysms must be considered in the presence of a callosal mass, even with negative angiography, especially if there has been evidence of bleeding from the lesion.
Among 293 subarachnoid hemorrhages admitted to the Neurology and Neurosurgery departments of Sta Maria Hospital, 108 patients had a normal cerebral angiography. Twenty-three meet the radiological criteria for perimesencephalic hemorrhage (center of the hemorrhage located in front of the mesencephalon, without blood in the interhemispheric and lateral sylvian fissures, nor significant intraventricular hemorrhage). The clinical picture was one of sudden, severe headache with meningeal signs, without focal signs or decreased alertness. Evolution was benign: there was no intrahospital mortality, morbidity or rebleeds on follow-up (3.5 years). In this subgroup of subarachnoid hemorrhage there is no need for a repeated angiogram if the first angiography is considered normal.
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Using Micropaque (crystallized barium sulphate) in a gelatinous medium of a certain viscosity, with a fluorescent pigment in the solution, we obtained a mixture with a fluidity adequate to a vascular injection; this injection is performed with a constant pressure, the values of which are kept between limits near the values of the physiological arterial pressure. We found several types of arterio-luminal vessels with different calibres: some of them with a calibre of 200 micrometer, some others of the intermediate type with a calibre between 100 and 200 micrometer, and others, which we call arterio-Thebesian vessels, originating in arteriolar branches opening in the Thebesian veins. At last, we have the arterio-sinusoido-cavity vessels opening in the ventricular cavities by several orifices.
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