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Background: Thrombosis of the internal jugular vein (IJV) is extremely rare, being central catheterization the most common cause. We present a case of a patient with an unusual appearance of neurological symptoms as a consequence of thrombosis of the IJV secondary to miliary tuberculosis. Case Description: A 30-year-old woman with disseminated tuberculosis, with multiple lymphadenopathy, axillary, cervical, mesenteric, retroperitoneal, and inguinal, presented with clinical evidence of intracranial hypertension. A diagnostic cerebral angiography was performed, which revealed an occluded left internal jugular and venous stasis in the entire cerebral venous system. The patient was treated with low-molecular-weight heparin, with which she had an adequate evolution. Conclusion: Tuberculosis is capable of generating a state of hypercoagulability, in addition to a mechanical compression effect due to cervical lymphadenopathy. We report an unusual clinical presentation, with intracranial involvement due to IJV thrombosis secondary to miliary tuberculosis. So far, there are no cases with a similar presentation described above.

Introduction: Degeneration of the cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the first research that compares the outcomes between the Anterior Approach (AA) and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. Materials and Methods: A retrospective observational study of electronic health records at the Hospital Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020 with patients older than 60 years submitted to cervical surgery. For the analysis we elaborated two groups according to the surgical approach: AA vs PA; we analyzed the trans-operative behavior, the immediate outcome, and after 3 months, 6 months, and 1 year. Results: As a total of 145 patients, the prevalence of CM in elderly was the 63.8% with a median age of 69 (64 -75) years. We found statistical differences in strength outcome only in the P3m (p = 0.011), for sensitivity we found major prevalence of affection in the PA group. We didn't report a significant difference in the Neck Disability Index (NDI) at all measures, but the PA presented a major incapacity. The Nurick scale results were significant in all stages (p < 0.05); and presented improvement compared with presurgical period (p < 0.001

Background: Choroid plexus papillomas (CPPs) are benign extra-axial tumors that originate from the choroid plexus; these tumors rarely have metastases, being at the spinal level the location with few reported cases. Case Description: We report the case of a 48-year-old man with a history of atypical fourth ventricular CPP and gross total resection (GTR) in 2008. In 2015, he presented with radicular pain, decreased strength, and paresthesia in the left leg. Magnetic resonance imaging revealed a well-defined intradural ovoid lesion in the vertebral canal at the level of the L3-L4 intersomatic space. Subtotal resection of the tumor was performed. The patient recovered well, with relief of pain and no neurological deficit. A literature research few cases of CPP metastasis in adults. We describe here a fifth-decade male patient with a lumbar neoplasm, which according to the histopathologic characteristics and location is the first case of an atypical papilloma implant of the choroid plexus at this spinal level. Conclusion: GTR of primary lesions and associated implants remains the gold standard for surgical treatment of CPP. Radiotherapy, stereotactic radiosurgery, and chemotherapy are adjuvant therapies for CPP but there is no definitive protocol for the management of implants. Proper follow-up of these patients is essential since spinal drop can appear many years after the initial presentation of CPP.

Introduction. Stroke is the fourth leading cause of death in the United States and the leading cause of disability. Of these, carotid artery disease is responsible for up to 15% to 30% of strokes. The objetive is knowing the risk factors and their impact on four possible scenarios in the diagnosis and treatment of carotid artery disease. 1: significant stenosis measured by ultrasound Doppler carotid, 2: significant stenosis measured by diagnostic cerebral angiography, 3: plaque ulceration measured by angiography, and 4: carotid stent placement. Material and Methods. A retrospective study was carried out with 29 patients, 12 patients to whom was placed a carotid stent and 17 control patients, Odds ratio was calculated for risk factors: high blood pressure, diabetes, cancer, smoking and dyslipidemia. And then multivariate analysis was performed with the same variables. Results. For the risk factors with statistical significance for carotid ulcer were dyslipidemia and cancer, and for stent placement, smoking, and clinically presented as a transient ischemic attack. For the multivariate analysis, the only factor associated with stent placement was smoking. Conclusions. Of the entire range of risk factors associated with cerebrovascular disease, tobacco use is the factor most strongly associated with a patient with carotid disease ending up in endovascular treatment. So prevention or lifestyle modification is the best tool to avoid these outcomes.

Introduction Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. Case report An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. Discussion The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. Conclusion This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction.