Cavernoma is a vascular malformation of the central nervous system. It occurs due to the excess of fibers of the cytoskeleton and anomalous opening of the interendothelial GAP junctions, allowing the extravasation of liquid component of the blood, with consequent formation of cave-like structures. The presente study aims to report the case of a male patient, 46 years old, with a history of right hemidystonia as a consequence of a thalamic stroke. After a neuromuscular blockade (NMB) with botulinum toxin type A (BTA), he showed improvement of the condition. Later he had another stroke in the same location, angiography and MRI were performed to confirm Cavernoma. Finally, he underwent resection of the angioma in the left thalamus. According to the literature, thalamic lesions constitute 1.5% of the predominant cavernoma locations, as well as being characterized as the most delicate. That said, after almost total excison of the lesion, the patient presented with right hemiparesis grade 4, dystonia of the right lower limb (RLL), clonus in the right Achilles, mild hypertonia of the right quadriceps, allodynia in the right hand and without evident signs of spasticity. In view of the situation, the conduct was the use of BTA in mm. quadriceps, soleus and gastrocnemius. Cavernoma resection, when properly performed in properly selected patients, is capable of obtaining satisfactory results with regard to symptomatic relief and improvement of quality of life.
Síndrome de Melkersson-Rosenthal complicada com hemiespasmo facial e hipertensão intracraniana Melkersson-Rosenthal syndrome complicated with facial hemiaspasm and intracranial hypertension
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