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Lemierre's syndrome refers to infectious thrombophlebitis of the internal jugular vein developed as complication of an oropharyngeal infection. It is a rare syndrome, affecting otherwise healthy young adults, which may lead to sepsis complicated by septic embolization. Although there is a characteristic clinical picture, many modern physicians are unaware of this syndrome, leading it to be termed ‘the forgotten disease’. The authors report a case of late diagnosis due to initial suspicion of COVID-19 and highlight the pitfalls on its diagnosis., Portuguese Journal of Cardiac Thoracic and Vascular Surgery, Vol. 29 No. 2 (2022): Apr-Jun

We present a retrospective study of 6 patients with spinal cord infarction in the territory of the Adamkiewicz artery. In all patients, the clinical picture was stereotyped: sudden onset of paraplegia and bilateral radicular pain, dissociated sensory loss below the level of infarction and sphincter dysfunction. Emergency neuroradiological investigation ruled out a compressive lesion in all cases. In one patient, spinal angiography was performed and identified an occlusion of the Adamkiewicz artery. Treatment was supportive and all patients had a substantial recovery over a period of weeks.

We report the clinical case of a 48-year-old woman with advanced renal cell carcinoma, and an inferior vena cava thrombus extending into the right atrium. The patient underwent complete tumor excision with radical nephrectomy and inferior vena cava trombectomy using adjunctive cardiopulmonary bypass and deep hypothermic circulatory arrest. Pathological studies revealed no capsular invasion by the renal cell carcinoma. Eighteen months postoperatively the patient is asymptomatic and on immunosuppressive therapy for suspected metastatic disease. We discuss the morbilidity, mortality and long term survival of patients with similar presentation of renal cell carcinoma based in a review of the published literature. Long term survival after surgical treatment is possible in a patient with localized renal cell carcinoma extending into the right atrium. In patient with localized renal cell carcinoma and inferior vena cava tumor thrombus the cephalad extent of inferior vena caval involvement does not appear to influence the prognosis.

The dural vascularization of the skull base and proximal nervous structures, depends on the external carotid artery, internal carotid artery and vertebral artery branches. The authors describe these branches, emphasizing possible anastomoses between them, and present images from their own experience. Such arterio-arterial anastomosis represent incomplete regressions of embryologic arterial connections and are always present, but functionally inactive. It is usually in the presence of pathologic situations (stroke, tumours, dural fistulas) that they become active and, therefore, special care is necessary if endovascular procedures with embolic material are to be performed.

Dural arterio-venous shunts (DAVS) of the anterior cranial fossa are quite rare. There are only a few cases reported in the literature. The authors present 5 cases of dural arterio-venous shunts (DAVS) of the anterior cranial fossa, allowing more data for later reviews of this rare and aggressive localisation of DAVS. The clinical set, imaging findings (with emphasis in diagnostic angiography), treatment and outcome in these 5 patients are described. Haemorrhage was the presenting form in 4 patients; the other case presented was investigated for headache. There were bilateral symmetric feeders in two patients, unilateral feeders in another two and unilateral predominant feeders in one; contribution of the external carotid artery, when present, was always minimal. Venous drainage included one or combinations of these: superior sagittal sinus, sylvian veins and cavernous sinus. Three patients had venous aneurysms in anterior cranial fossa; of these, two presented with haemorrhage, but the third one of them has been asymptomatic for 7 years. Three patients were treated by surgical exclusion of the shunt and became clinical and angiographicaly normal. According to the literature, our cases confirm the highly aggressive behaviour of these DAVS. Surgical treatment is an efficacious method of therapy and should be done as soon as possible. Embolization can be attempted but is technically difficult and eventually too expensive.

A case of type V intracranial dural arteriovenous fistula (DAVF) is reported because of its unusual rapidly progressive paraparesis. Despite this clinical presentation, the diagnosis of DAVF was made and precocious endovascular treatment was instituted. Angiographic normalization was obtained after embolisation and the patient significantly improved within the first weeks, although at the six month control MRI there still was a hyperintense signal of the cord in T2 weighted images, but less extensive than originally.

In this retrospective study we have analysed a series of 38 patients seen from 1983 to 1992 (mean follow-up, 4.5 years) with active neurocysticercosis (NCC), 23 (60.5%) with parenchymal and 15 (39.5%) with extraparenchymal NCC. Classification into these two forms of NCC was based on computed tomography and magnetic resonance imaging criteria. The enzyme-linked immunosorbent assay performed in cerebrospinal fluid, for anti-Taenia solium antibodies, was positive in 18 of 23 (78%) cases. Epilepsy and/or intracranial hypertension were the most common clinical presentation (92%). Twenty-three (60.5%) of 38 patients were treated with praziquantel and/or albendazole. In parenchymal NCC, the efficacy of medical therapy was complete in 13 of 16 (81%) and partial in 3 of 16 (19%) patients. In contrast, in all cases of extraparenchymal NCC treated with cysticidal drugs the results were disappointing. A ventriculoperitoneal shunt was performed in 9 of 13 patients with extraparenchymal NCC and hydrocephalus. Severe complications, including two deaths, associated with the natural evolution of the disease or with surgery, occurred only in extraparenchymal NCC. Therefore, we confirm the existence of the two forms of active NCC, parenchymal and extraparenchymal, which are strikingly different in clinical presentation, medical therapy response, complications, morbidity and mortality.

Acute encephalopathy is a recognized toxic effect of Cyclosporin A (CsA) in organ transplantation recipients. A 16-year-old girl presented with acute encephalopathy 2 weeks after CsA and methylprednisolone medication for idiopathic uveitis. Magnetic resonance imaging showed cortical and white matter occipital changes, which were not visible 2 months later. With expanding indication for CsA use, an increasing number of neurotoxic cases are to be expected.

This paper presuposes an informed knowlege of the picture archives and communication system (PACS) which, therefore, shall be only discussed in its functional and not structural aspects.

Acute encephalopathy is a recognized toxic effect of Cyclosporin A (CsA) in organ transplantation recipients. A 16-year-old girl presented with acute encephalopathy 2 weeks after CsA and methylprednisolone medication for idiopathic uveitis. Magnetic resonance imaging showed cortical and white matter occipital changes, which were not visible 2 months later. With expanding indication for CsA use, an increasing number of neurotoxic cases are to be expected.

Incidence and radiologic findings of neurocysticercosis were investigated in a series of 23 800 consecutive head examinations using computed tomography (CT). The condition was diagnosed in 168 cases (0.7%). The parenchymatous form was the most common presentation (96.3%), while the meningeal form corresponded to only 11.9 per cent of cases. These two forms coexisted in some cases. These findings reversed the knowledge on the condition based on conventional radiography. The different CT appearances in the brain are described and a new radiologic protocol for the CT evaluation of the condition is advocated, which includes a follow-up after a trial cure with Praziquantel in the presence of cysts not associated with suggestive brain calcifications. CT was more sensitive than conventional radiography in the differentiation between dead and living larvae, thus having an impact on the therapeutic management of the patients.

Incidence and radiologic findings of neurocysticercosis were investigated in a series of 23 800 consecutive head examinations using computed tomography (CT). the condition was diagnosed in 168 cases (0.7%). the parenchymatous form was the most common presentation (96.3%), while the meningeal form corresponded to only 11.9 per cent of cases. These two forms coexisted in some cases. These findings reversed the knowledge on the condition based on conventional radiography. the different CT appearances in the brain are described and a new radiologic protocol for the CT evaluation of the condition is advocated, which includes a follow-up after a trial cure with Praziquantel in the presence of cysts not associated with suggestive brain calcifications. CT was more sensitive than conventional radiography in the differentiation between dead and living larvae, thus having an impact on the therapeutic management of the patients

Incidence and radiologic findings of neurocysticercosis were investigated in a series of 23,800 consecutive head examinations using computed tomography (CT). The condition was diagnosed in 168 cases (0.7%). The parenchymatous form was the most common presentation (96.3%), while the meningeal form corresponded to only 11.9 per cent of cases. These two forms coexisted in some cases. These findings reversed the knowledge on the condition based on conventional radiography. The different CT appearances in the brain are described and a new radiologic protocol for the CT evaluation of the condition is advocated, which includes a follow-up after a trial cure with Praziquantel in the presence of cysts not associated with suggestive brain calcifications. CT was more sensitive than conventional radiography in the differentiation between dead and living larvae, thus having an impact on the therapeutic management of the patients.