The purpose of this study was to describe the vascular architecture and blood supply to the hamster cheek pouch and to measure the intravascular pressure distribution in the entire pouch. Previous anatomic descriptions have focused either on the vasculature of the facial region or on the microcirculation of the cheek pouch tip. Micropressures in cheek pouch capillaries, terminal arterioles, and small venules have not previously been measured. Cheek pouches were prepared for examination under an intravital microscope using both everted and noneverted methods. Microvessel diameters were measured through a video system using a video micrometer, and intravascular hydrostatic pressures were measured with a servo null micropressure system. Blood vessels in the face and pouch were traced after injection of Microfil into the external maxillary artery. The results indicate that the pouch is supplied directly or indirectly by six small arteries in the neck and face. Fifty percent of the total pressure drop across the cheek pouch vasculature occurs in the small cheek pouch arteries, suggesting that these vessels are potentially important in controlling cheek pouch blood flow. The measurements of microvascular pressures and diameters in this study help clarify apparent discrepancies in similar measurements from previous studies.
Background: Despite surgical resection of primary central nervous system lymphomas (PCNSL) having been always discouraged, recent evidence supports that it might improve prognosis in this patient population. Five- aminolevulinic acid-derived fluorescence is widely used for the resection of malignant gliomas, but its role in PCNSL surgery remains unclear. Case Description: We present two patients with a solitary solid intraparenchymal mass. As high-grade glioma leaded the list of differential diagnosis (other possibilities were metastasis, abscess, and PCNSL), a five- aminolevulinic acid-guided complete resection (with strong fluorescence in both cases) was done. Surgery was uneventfully carried on with complete resection until five-aminolevulinic acid-induced fluorescence was no longer evident. After surgery, patients have no neurological deficits and had good recovery. Pathological examination revealed that both tumors were PCNSL. Adjuvant radiotherapy and chemotherapy were started. After 1 year of follow-up, patients have good evolution and have no recurrences. Conclusion: These cases add to the growing literature which shows that surgery might play an important role in the management of PCNSL with an accessible and single lesion. Five-aminolevulinic acid could also be a useful tool to achieve complete resection and improve prognosis in this group of patients.
We report a case of progressive supranuclear palsylike parkinsonism associated with giant perivascular spaces (GPVS). An 80-year-old patient consulted for progressive gait unsteadiness. Clinical assessment revealed gait unsteadiness, bradykinesia, rigidity, and vertical ophthalmoparesis, with no other alterations. An MRI showed GPVS and severe displacement of the midbrain; the GPVS also extended into the right thalamus (figures 1 and 2). Despite this finding, the patient has remained stable for the last 10 years in terms of clinical and radiologic findings, and is independent for activities of daily living except for walking by himself. This case illustrates the power of brain plasticity. Despite severe midbrain destruction, a slow evolution of the lesion has allowed for successful adaptation. 1,2 AUTHOR CONTRIBUTIONS Pierre Ferrer: primary author; study concept and design; acquisition, analysis, and interpretation of data. Julia Montoya: coauthor; analysis and interpretation of data. Pedro J. García Ruiz: coauthor; study concept and design; analysis and interpretation of data; study supervision. STUDY FUNDING No targeted funding reported. DISCLOSURE P. Ferrer and J. Montoya report no disclosures relevant to the manuscript. P. García Ruiz received speech honoraries from Hatfarmaco, Allergan, Merz, Zambon, and Bial. Go to Neurology.org for full disclosures.
Aim This article aims to describe the case of a 43-year-old male with a neurogenic thoracic outlet syndrome caused by a C7 transverse mega-apophysis. Background Cervical transverse mega-apophysis, transverse apophysomegaly, or elongation of the transverse vertebral process represents a variation of normal skeletal anatomy. This variation has been little studied and its prevalence in the population is unknown because it often exists without symptoms. It is estimated that less than 10% of cases are symptomatic. Case description We present a rare case of a man with a neurogenic thoracic outlet syndrome (in this case, a left plexopathy) caused by a cervical transverse mega-apophysis. After surgical intervention, the patient improved and after a 1-year follow-up, he remained asymptomatic. Conclusion Even though some authors describe cervical pain associated with this condition, we found very few data regarding plexopathy or other neurological symptoms caused by a cervical transverse apophysomegaly. How to cite this article Ferrer P, Álvarez AS, Penanes JR. Cervical Transverse Mega-apophysis: A Rare Cause of Plexopathy. Int J Head Neck Surg 2021;12(1):40–42.
Background: Factors that are known to cause lumbar epidural venous plexus (EVP) engorgement include inferior vena cava (IVC) obstruction, portal hypertension, vascular agenesis, morbid obesity, and/or hypercoagulable states. Here, we present a 32-year-old female admitted with the new onset of lumbar radiculopathy attributed to a gastric balloon causing compression of the IVC and engorgement of the EVP. Case Description: A 32-year-old female was admitted with a left L5 radiculopathy. She had a history of morbid obesity and had undergone intragastric balloon insertion 4 months ago. The abdominal/pelvic CT documented an intragastric balloon producing a voluminous gastric mass with resultant compression of the IVC. The lumbar MRI showed the resultant marked multilevel engorgement of the lumbar EVP. Here, following balloon removal, the patient was immediately symptom free and remained asymptomatic over the next postoperative year. Conclusion: An intragastric balloon can produce a voluminous gastric mass that can result in IVC occlusion and engorgement of the EVP, leading to lumbar radiculopathy. Removal of the balloon results in immediate and permanent resolution of the compressive symptoms.
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