Publication: Fístulas raquídeas postraumáticas de LCR en carnívoros domésticos: evaluación mediante Imagen de Resonancia Magnética-Mielografía con inyección de contraste paramagnético intratecal
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2017-08-02
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Universidad Complutense de Madrid
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Abstract
El diagnóstico de fístulaS raquídeaS de LCR, secundarias a desgarros o laceraciones durales, ya sean espontánea o postraumática, sigue siendo un reto diagnóstico en seres humanos y animales. En el contexto de traumatismo de la médula la detección de desgarros durales raquídeos es importante porque tales defectos pueden atrapar de forma aguda raíces nerviosas. Además, los desgarros durales aumentan el riesgo de meningitis, que puede causar un mayor desgarro dural y promover su apertura permanente, lo que a su vez puede conducir al desarrollo de meningocele postraumático. El meningocele sí tiene entonces el potencial de actuar como un foco crónico para el atrapamiento de la raíz nerviosa. Sin embargo, los desgarros durales y laceraciones son clínica y radiológicamente muy difíciles de diagnosticar. Se sabe que en humanos los traumatismos severos raquídeos, que además presentan fístula de LCR, confieren un peor pronóstico por esta específica complicación. Este subtipo de traumatismos presenta riesgo adicional de meningitis de repetición, así como aracnoiditis progresivas. Por ello es importante una prueba neurorradiológica fiable en su detección. Hasta ahora, dentro del cierto desconocimiento de esta complicación, el método de referencia era la TC‐ Mielografía. Se sabe actualmente que las imágenes de RM con inyección intratecal de contraste paramagnético permiten detectar con más sensibilidad y exactitud si existe o no fístula, su extensión y daños medulares asociados. El presente trabajo es un estudio de investigación neurorradiológica realizado en animales, sin que se hayan sacrificado especímenes al efecto, sino como resultado de la atención en Medicina Veterinaria, con traslación potencial a humanos....
The diagnosis of spinal cerebrospinal fluid CSF fistulae secondary to dural tears, rents, or lacerations, whether spontaneous or post‐traumatic, remains a diagnostic challenge in both humans and animals. In the spinal trauma setting, the detection of spinal dural tears is important because such defects can acutely entrap nerve roots. In addition, dural tears increase the risk of meningitis, which can cause a dural laceration and promote its remaining opening indefinitely, which may in turn lead to the development of post‐traumatic meningocele. The meningocele itself then has the potential to act as a chronic focus for nerve root entrapment. However, dural tears and lacerations are clinically and radiologically very difficult to diagnose. On radiological grounds, before the computed era, dural tears were diagnosed radiologically through myelography which is no longer used in humans because its low sensitivity and potential hazards. Plain CT has low sensitivity and low specificity for the detection of spinal meningeal injury. Although CT myelography using water‐soluble iodinated contrast medium overcomes some of these limitations, it appears that gadolinium‐enhanced MR cisternography/myelography is superior in the evaluation of dural leaks, including spinal leaks. It is known that in human spinal trauma who also have severe CSF fistulae have poorer prognosis for this specific complication. This subtype of trauma presents additional risk of recurrent meningitis and progressive arachnoiditis. It is therefore important to obtain neuroradiological a reliable test for its diagnosis. This is a study of neuroradiological research conducted in small carnivores without sacrifying any specimen for the purpose, but as a result of care in Veterinary Medicine, with potential translational to humans...
The diagnosis of spinal cerebrospinal fluid CSF fistulae secondary to dural tears, rents, or lacerations, whether spontaneous or post‐traumatic, remains a diagnostic challenge in both humans and animals. In the spinal trauma setting, the detection of spinal dural tears is important because such defects can acutely entrap nerve roots. In addition, dural tears increase the risk of meningitis, which can cause a dural laceration and promote its remaining opening indefinitely, which may in turn lead to the development of post‐traumatic meningocele. The meningocele itself then has the potential to act as a chronic focus for nerve root entrapment. However, dural tears and lacerations are clinically and radiologically very difficult to diagnose. On radiological grounds, before the computed era, dural tears were diagnosed radiologically through myelography which is no longer used in humans because its low sensitivity and potential hazards. Plain CT has low sensitivity and low specificity for the detection of spinal meningeal injury. Although CT myelography using water‐soluble iodinated contrast medium overcomes some of these limitations, it appears that gadolinium‐enhanced MR cisternography/myelography is superior in the evaluation of dural leaks, including spinal leaks. It is known that in human spinal trauma who also have severe CSF fistulae have poorer prognosis for this specific complication. This subtype of trauma presents additional risk of recurrent meningitis and progressive arachnoiditis. It is therefore important to obtain neuroradiological a reliable test for its diagnosis. This is a study of neuroradiological research conducted in small carnivores without sacrifying any specimen for the purpose, but as a result of care in Veterinary Medicine, with potential translational to humans...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Veterinaria, leída el 20/05/2016