Assuntos
Disfunção Cognitiva/etiologia , Delírio de Parasitose/etiologia , Demência Vascular/complicações , Idoso de 80 Anos ou mais , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Delírio de Parasitose/tratamento farmacológico , Demência Vascular/diagnóstico , Feminino , Humanos , Hiperglicemia/complicações , Hiperglicemia/dietoterapia , Leucoaraiose/complicações , Leucoaraiose/diagnóstico , Fumarato de Quetiapina/administração & dosagem , Fumarato de Quetiapina/uso terapêuticoAssuntos
Ecolalia/etiologia , Paralisia Supranuclear Progressiva/complicações , Idoso , Atrofia , Corpo Estriado/diagnóstico por imagem , Ecolalia/patologia , Ecolalia/fisiopatologia , Função Executiva , Feminino , Lobo Frontal/patologia , Lobo Frontal/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Mesencéfalo/patologia , Córtex Motor/patologia , Córtex Motor/fisiopatologia , Testes Neuropsicológicos , Cintilografia , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Paralisia Supranuclear Progressiva/fisiopatologiaRESUMO
TITLE: Variante del signo de la cara del panda gigante.
Assuntos
Gânglios da Base/patologia , Degeneração Hepatolenticular/diagnóstico , Imageamento por Ressonância Magnética , Mesencéfalo/patologia , Neuroimagem/métodos , Adulto , Gânglios da Base/química , Química Encefálica , Cobre/análise , Cobre/urina , Degeneração Hepatolenticular/patologia , Degeneração Hepatolenticular/urina , Humanos , Ferro/análise , Masculino , Mesencéfalo/químicaRESUMO
Deep brain stimulation (DBS) is an established surgical therapy for intractable movement disorders, such as Parkinson's disease, essential tremor and dystonia. As the number of treated patients has increased rapidly, new sets of problems about complications of DBS have arisen. Bowstringing is defined as abnormal tethering of leads between the pulse generators and stimulating electrode, associated with pain and contracture of the neck over the extension cable. We report the case of a 56-year-old woman with a history of advanced Parkinson's disease who had been treated by implantation of a bilateral, subthalamic nucleus, deep brain stimulator. A car accident caused the rupture of the right electrode, which was replaced. Six months after the replacement the patient presented disabling pain and tension in the neck where deep brain extension cables were located. A cervical incision was performed to excise scar tissue. Bowstringing is a rare complication of DBS and although patients sometimes report discomfort and tension in the cervical region, surgical procedures are not normally required.
Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Eletrodos Implantados/efeitos adversos , Migração de Corpo Estranho/etiologia , Cervicalgia/etiologia , Acidentes de Trânsito , Cicatriz/etiologia , Remoção de Dispositivo , Falha de Equipamento , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Movimentos da Cabeça , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Imagem Multimodal , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Estresse Mecânico , Tomografia Computadorizada por Raios XRESUMO
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.