Arquivos de neuro-psiquiatria
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In a 52-year-old woman, spinal arteriovenous malformation (AVM) has been associated with what has been known as Foix-Alajouanine syndrome. The pathophysiology of the AV fistula is probably related to increased venous pressure from the AVM plus thrombotic process. ⋯ Nevertheless, in this case, suggestive defects of malformations could not be seen, in contrast to the MRI findings and macroscopical and anatomical-pathological lesion. These findings rise our attention, about the need to keep in mind the clinical suspicion of AVM in cases of back pain and motor deficit, and an early surgical conduct in this situation.
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Valproic acid has been widely used for the treatment of epilepsy. Although it is usually well tolerated, it has been associated with some side effects. A poor studied side effect is the hyperammonemia, which independs from the drug hepatotoxic action. ⋯ The hypothesis of secondary effect to the valproic acid was reinforced by the normalization of ammonia levels after drug withdrawal. The pathogenesis of valproate-induced hyperammonemia have been discussed. We conclude that routine monitoring of ammonia blood concentration are strongly recommended in patients under valproic acid treatment.
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There is no clear role for decompressive craniotomy (DC) for the intracranial hypertension (ICH) treatment in the literature. Actually, there is a lack of class I or II published data for DC, so it is recomended as a second tier option for the refractory ICH. Recent studies has analized the role of early DC for pos traumatic ICH. ⋯ Hydrocephalus was frequent after DC (28.5%). Good results were obtained in 11 patients (52.5%). We favour the early application of DC for pos traumatic hypertension.