RESUMO
A wide variety of diseases present with intracranial lesions. In this case report, a 67-year-old man initially presented to an outside hospital with nausea, headache, and ataxia and was found to have multiple intracranial lesions. Diagnostic workup was ultimately unrevealing, and his condition improved after a course of steroids and antibiotics. Unfortunately, symptoms returned 3 months later. MRI of the brain revealed progression of his intracranial lesions. This case highlights a diagnostic approach and general management strategy for patients presenting with undifferentiated intracranial pathology. A final diagnosis is ultimately reached and raises further discussion.
Assuntos
Antibacterianos , Encéfalo , Infecções Protozoárias do Sistema Nervoso Central , Hemianopsia , Humanos , Masculino , Idoso , Hemianopsia/etiologia , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Infecções Protozoárias do Sistema Nervoso Central/diagnóstico , Infecções Protozoárias do Sistema Nervoso Central/tratamento farmacológico , Naegleria fowleri , Antibacterianos/uso terapêutico , Resultado do TratamentoRESUMO
Within the field of neurology, there has been limited discussion of how to best respect patient autonomy in patients presenting with an acute stroke, who often have impairments in language and cognition. In addition to performing a detailed neurologic examination and providing a thorough timeline of their current presentation and medical history, these patients and their families are then asked to quickly make critical medical decisions regarding acute stroke therapies (thrombolysis and endovascular therapy). These discussions are often limited by time constraints and inadequate opportunities for patient education regarding acute stroke care. This article discusses some of the challenges of preserving patient autonomy in patients presenting with acute stroke and the advent of a stroke advance directive (Coordinating Options for Acute Stroke Therapy [COAST]) aimed to overcome these obstacles.
Assuntos
Tronco Encefálico/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Mielite/diagnóstico por imagem , Adulto , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/terapia , Angiografia Cerebral , Vértebras Cervicais , Diagnóstico Diferencial , Embolização Terapêutica , Feminino , Traumatismos Cranianos Fechados/complicações , Humanos , Imageamento por Ressonância Magnética , Paraplegia/etiologiaAssuntos
Encefalite Viral/diagnóstico , Cefaleia/diagnóstico , Influenza Humana/diagnóstico , Convulsões/diagnóstico , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Encefalite Viral/tratamento farmacológico , Feminino , Cefaleia/tratamento farmacológico , Humanos , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Período Pós-Parto , Convulsões/tratamento farmacológico , Adulto JovemRESUMO
Metaplasticity, the adaptive changes of long-term potentiation (LTP) and long-term depression (LTD) in response to fluctuations in neural activity is well documented in visual cortex, where dark rearing shifts the frequency threshold for the induction of LTP and LTD. Here we studied metaplasticity affecting spike-timing-dependent plasticity, in which the polarity of plasticity is determined not by the stimulation frequency, but by the temporal relationship between near-coincidental presynaptic and postsynaptic firing. We found that in mouse visual cortex the same regime of deprivation that restricts the frequency range for inducing rate-dependent LTD extends the integration window for inducing timing-dependent LTD, enabling LTD induction with random presynaptic and postsynaptic firing. Notably, the underlying mechanism for the changes in both rate-dependent and time-dependent LTD appears to be an increase of NR2b-containing NMDAR at the synapse. Thus, the rules of metaplasticity might manifest in opposite directions, depending on the plasticity-induction paradigms.