Stent infection is extremely rare, especially in stents placed in the internal carotid artery (ICA). Treatment in these cases remains controversial and no consensus has been reached, resulting in high mortality in all cases. We report the case of a 78-year-old man undergoing stent placement in the left ICA who, 20 days later, presented with infection at the stent site and a large pseudoaneurysm. The primary infectious focus was the teeth. The patient was treated with antibiotics and placement of a Casper stent, a dual layer braided metal stent with micro-mesh, intended to determine flow diversion and arterial wall reconstruction. Although the procedure was able to reduce the pseudoaneurysm, the patient eventually died of sepsis. We believe that the use of dual layer stents, with a flow-diverting effect, may be a treatment option in selected cases. However, further studies are needed to confirm this hypothesis.
O hematoma subdural é uma complicação incomum e grave do uso da técnica de raquianestesia. A primeira manifestação clínica usualmente é cefaleia. Apresentamos o caso de uma puérpera de 29 anos submetida a raquianestesia para parto cesariano que desenvolveu hematoma subdural. A paciente foi submetida a tratamento conservador, sem necessidade de intervenção neurocirúrgica com boa evolução. O hematoma subdural pós-raquianestesia é uma patologia grave que sempre deve ser suspeitada em pacientes com cefaleia, principalmente quando associada a outras manifestações neurológicas, para diferenciar de outras patologias associadas, como a hipotensão liquórica por punção dural.
Context: Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are arteriovenous connections located in the dura mater leaflets of this region. DAVFs usually present with ocular symptoms such as diplopia, conjunctival hyperemia, involvement of cranial nerves III/IV/VI, etc. Trigeminal neuralgia caused by a cavernous DAVF is rare, being reported only three times in the literature. Case report: A 46-year-old female smoker sought care with a complaint of multiple daily episodes of shock-like right temporal headache and facial pain in the V1/V2 dermatomes, of 2 years’ duration. A clinical diagnosis of trigeminal neuralgia was established. Magnetic resonance (MR) imaging of the brain and MR angiography of the cerebral and cervical vessels were both normal. Conservative treatment and balloon compression of the trigeminal ganglion were ineffective. Therefore, we chose to perform an angiography for diagnostic clarification, which demonstrated a DAVF of the right cavernous sinus, fed by branches of the external carotid artery. We decided to catheterize the fistula and complete obliteration was achieved. Soon after the procedure the patient reported pain relief. At 3-month follow-up the patient remained pain free and required no analgesia. Conclusion: Trigeminal neuralgia caused by a cavernous DAVF is rare. The fistula in this case was only diagnosed after an angiography was performed, so clinicians must be aware that not all vascular conditions can be identified non invasively, and that cavernous DAVFs may be an underdiagnosed cause of trigeminal neuralgia.
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