RESUMO
BACKGROUND AND PURPOSE: The computed tomographic angiography spot sign as a predictor of hematoma expansion is limited by its modest sensitivity and positive predictive value. It is possible that hematoma expansion in spot-positive patients is missed because of decompression of intracerebral hemorrhage (ICH) into the ventricular space. We hypothesized that revising hematoma expansion definitions to include intraventricular hemorrhage (IVH) expansion will improve the predictive performance of the spot sign. Our objectives were to determine the proportion of ICH nonexpanders who actually have IVH expansion, determine the proportion of false-positive spot signs that have IVH expansion, and compare the known predictive performance of the spot sign to a revised definition incorporating IVH expansion. METHODS: We analyzed patients from the multicenter PREDICT ICH spot sign study. We defined hematoma expansion as ≥6 mL or ≥33% ICH expansion or >2 mL IVH expansion and compared spot sign performance using this revised definition with the conventional 6 mL/33% definition using receiver operating curve analysis. RESULTS: Of 311 patients, 213 did not meet the 6-mL/33% expansion definition (nonexpanders). Only 13 of 213 (6.1%) nonexpanders had ≥2 mL IVH expansion. Of the false-positive spot signs, 4 of 40 (10%) had >2 mL ventricular expansion. The area under the curve for spot sign to predict significant ICH expansion was 0.65 (95% confidence interval, 0.58-0.72), which was no different than when IVH expansion was added to the definition (area under the curve, 0.66; 95% confidence interval, 0.58-0.71). CONCLUSIONS: Although IVH expansion does indeed occur in a minority of ICH nonexpanders, its inclusion into a revised hematoma expansion definition does not alter the predictive performance of the spot sign.
Assuntos
Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Hematoma Subdural Intracraniano/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral Intraventricular/fisiopatologia , Hemorragia Cerebral Intraventricular/cirurgia , Reações Falso-Positivas , Feminino , Hematoma Subdural Intracraniano/fisiopatologia , Hematoma Subdural Intracraniano/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND PURPOSE: Hematoma expansion in intracerebral hemorrhage is associated with higher morbidity and mortality. The computed tomography (CT) angiographic spot sign is highly predictive of expansion, but other morphological features of intracerebral hemorrhage such as fluid levels, density heterogeneity, and margin irregularity may also predict expansion, particularly in centres where CT angiography is not readily available. METHODS: Baseline noncontrast CT scans from patients enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study were assessed for the presence of fluid levels and degree of density heterogeneity and margin irregularity using previously validated scales. Presence and grade of these metrics were correlated with the presence of hematoma expansion as defined by the PREDICT study on 24-hour follow-up scan. RESULTS: Three hundred eleven patients were included in the analysis. The presence of fluid levels and increasing heterogeneity and irregularity were associated with 24-hour hematoma expansion (P=0.021, 0.003 and 0.049, respectively) as well as increases in absolute hematoma size. Fluid levels had the highest positive predictive value (50%; 28%-71%), whereas margin irregularity had the highest negative predictive value (78%; 71%-85). Noncontrast metrics had comparable predictive values as spot sign for expansion when controlled for vitamin K, antiplatelet use, and baseline National Institutes of Health Stroke Scale, although in a combined area under the receiver-operating characteristic curve model, spot sign remained the most predictive. CONCLUSIONS: Fluid levels, density heterogeneity, and margin irregularity on noncontrast CT are associated with hematoma expansion at 24 hours. These markers may assist in prediction of outcomes in scenarios where CT angiography is not readily available and may be of future help in refining the predictive value of the CT angiography spot sign.
Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Progressão da Doença , Hematoma/diagnóstico por imagem , Hematoma/epidemiologia , Tomografia Computadorizada por Raios X , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly. On second day of admission he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of acute respiratory distress syndrome (ARDS). The patient had to be intubated. Continuous renal replacement therapy (CRRT) was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient succumbed to illness. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on ABG and was corrected accordingly. On second day of admission, he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of ARDS. The patient had to be intubated on day 2. CRRT was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient gradually deteriorated, had cardiac arrest and passed away on day 5 of his hospital stay.
Assuntos
Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Lavagem Gástrica/métodos , Malpighiales , Extratos Vegetais/intoxicação , Intoxicação/terapia , Suicídio , Acidose/induzido quimicamente , Acidose/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação/etiologia , Terapia de Substituição Renal , Síndrome do Desconforto Respiratório/induzido quimicamente , Síndrome do Desconforto Respiratório/terapiaRESUMO
A 24-year-old woman came to the emergency room of our hospital, 6 hours after a sting to the pulp of her middle finger of her left upper limb by an Indian red scorpion. On examination, she had tachycardia, tachypnoea, hypotension and low oxygen saturation at room temperature. On auscultation, there was poor air entry in all areas of the right lung along with crackles. The left lung field was normal on auscultation. Chest X-ray showed unilateral haziness of right lung field. Two-dimensional echocardiography showed clinical findings of myocarditis. Arterial blood gas showed metabolic acidosis with severe hypoxaemia, suggestive of type 1 respiratory failure. After intubation and initiating ventillatory support, the patient was given intravenous analgesics, antihistaminic and infiltrated of site of bite with 2% xylocaine. The patient was started on inotropes, alpha receptor blocker, intravenous steroids, bronchodilators and diuretics support. The patient clinically improved over the course of treatment and was subsequently discharged.
Assuntos
Miocardite/diagnóstico por imagem , Edema Pulmonar/etiologia , Picadas de Escorpião/fisiopatologia , Venenos de Escorpião/intoxicação , Adulto , Anestésicos Locais/uso terapêutico , Animais , Broncodilatadores/uso terapêutico , Diuréticos/uso terapêutico , Eletrocardiografia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Miocardite/fisiopatologia , Miocardite/terapia , Radiografia Torácica , Respiração Artificial , Insuficiência Respiratória , Picadas de Escorpião/complicações , Picadas de Escorpião/tratamento farmacológico , Escorpiões , Resultado do TratamentoRESUMO
Ocular myiasis is a rare disease with invasion of the lids, conjunctiva, cornea and, rarely, orbit or globe of the mammalian eye by dipteral larvae.We report a case of a 74-year-old woman with chronic, infiltrating, ulcerative lesion of the left lower eyelid, which was confirmed as basal cell carcinoma subsequently, having ophthalmomyiasis.She was a destitute, living in unhygienic environmental conditions and having poor general health. She developed permanent blindness as a result of ophthalmomyiasis of the left eye. Proper wound care, hygiene and adequate nutrition helped her recover from the illness.
Assuntos
Carcinoma Basocelular/complicações , Neoplasias Palpebrais/complicações , Miíase/complicações , Neoplasias Cutâneas/complicações , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Desbridamento , Enucleação Ocular , Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/patologia , Neoplasias Palpebrais/cirurgia , Feminino , Humanos , Inseticidas/uso terapêutico , Ivermectina/uso terapêutico , Miíase/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Sulbactam/uso terapêutico , Irrigação Terapêutica , Tomografia Computadorizada por Raios XRESUMO
We report a 57-year-old man presenting with symptoms of sharp pricking, exertional retrosternal chest pain multiple times, each episode lasting for a few seconds. On evaluation, the ECG of the patient showed normal sinus rhythm with T wave inversions in leads V1-V3. Troponin T test was negative. Transthoracic echocardiography showed a globular mass in the interventricular septum. Cardiac MRI was suspicious of the lesion to be a hydatid cyst. Surgical excision of the lesion followed by histopathology was confirmatory of hydatid cyst.
Assuntos
Dor no Peito/etiologia , Equinococose/diagnóstico , Cardiopatias/parasitologia , Septo Interventricular/parasitologia , Equinococose/cirurgia , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/cirurgiaRESUMO
We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.
Assuntos
Córtex Cerebral/patologia , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico , Enxaqueca com Aura/complicações , Enxaqueca com Aura/diagnóstico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Aspirina/uso terapêutico , Córtex Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Diagnóstico Diferencial , Feminino , Flunarizina/uso terapêutico , Frutose/análogos & derivados , Frutose/uso terapêutico , Humanos , Imageamento por Ressonância Magnética/métodos , Enxaqueca com Aura/terapia , Naproxeno/uso terapêutico , Necrose , Reabilitação do Acidente Vascular Cerebral/métodos , TopiramatoRESUMO
A 40-year-old woman presented with insidious onset, gradually progressive dysarthria and inability to manoeuvre bolus of food in her mouth while eating. The duration of her symptoms was 3 months. On evaluation, the left half of her tongue was wasted. The tongue deviated to the left on protrusion. There were no clinical features suggestive of involvement of the ipsilateral 9th, 10th or 11th cranial nerves. MRI of the brain showed a large, fusiform lesion in the left hypoglossal canal, extending into the jugular canal. The lesion was surgically excised and found to be a schwannoma.
Assuntos
Doenças dos Nervos Cranianos/patologia , Doenças do Nervo Hipoglosso/patologia , Nervo Hipoglosso/patologia , Neurilemoma/patologia , Adulto , Doenças dos Nervos Cranianos/etiologia , Diagnóstico Diferencial , Disartria/diagnóstico , Disartria/etiologia , Feminino , Humanos , Doenças do Nervo Hipoglosso/complicações , Laringoscopia/métodos , Imageamento por Ressonância Magnética/métodos , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Língua/patologia , Doenças da Língua/patologia , Resultado do TratamentoRESUMO
We report a 54-year-old woman with scorpion bite. After 3 hours of admission, the patient developed sudden onset tachycardia with hypotension. Cardiac evaluation showed raised creatine kinase MB isoenzyme was elevated; ECG and two-dimensional echocardiography findings were suggestive of myocarditis. Subsequently, she developed transient ventricular tachycardia before developing abrupt onset, right hemiplegia, global aphasia and progressive worsening of sensorium 12 hours after the bite. MRI of brain revealed massive left middle cerebral artery (MCA) territory infarct. The magnetic resonance angiography showed non-visualisation of left internal carotid artery (ICA) and MCA. Coagulation parameters were normal. Sudden complete occlusion of left ICA was probably secondary to cardioembolic phenomenon leading to massive infarct. Despite aggressive medical and supportive measures, she clinically worsened rapidly to Glasgow Coma Scale of 3/15 over next 6 hours and succumbed to her illness the next day.
Assuntos
Catecolaminas/sangue , Parada Cardíaca/etiologia , Infarto da Artéria Cerebral Média/etiologia , Picadas de Escorpião , Acidente Vascular Cerebral/etiologia , Animais , Biomarcadores/sangue , Catecolaminas/efeitos adversos , Angiografia Cerebral , Clopidogrel , Evolução Fatal , Feminino , Humanos , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/terapia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Escorpiões , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Ticlopidina/administração & dosagem , Ticlopidina/análogos & derivadosAssuntos
Abscesso Encefálico/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Lobo Occipital/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem , Adolescente , Anticonvulsivantes/uso terapêutico , Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Calcinose/complicações , Calcinose/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Lobo Occipital/cirurgia , Convulsões/tratamento farmacológico , Convulsões/etiologia , Lobo Temporal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We describe a patient who presented with a neurovisceral syndrome characterised by ataxia, bulbar dysfunction, supranuclear gaze palsy, splenomegaly and foamy histiocytes in the bone marrow. This presentation was suggestive of a lysosomal storage disorder such as Niemann-Pick disease type C or Gaucher's disease type 3. We review the presentation of these disorders, with a focus on the neurological features. In addition, we briefly discuss the disease-modifying therapeutic options which have recently become available.
Assuntos
Doença de Gaucher/diagnóstico , Doenças de Niemann-Pick/diagnóstico , Adulto , Diagnóstico Diferencial , Terapia de Reposição de Enzimas , Feminino , Doença de Gaucher/tratamento farmacológico , Glucosidases/uso terapêutico , Humanos , Esfingomielina Fosfodiesterase/uso terapêuticoRESUMO
We report a case of a 28-year-old man who presented with 1-day history of sudden diminution of vision in the right eye. Examination showed unilateral exophthalmos with restricted eyeball movement on upward gaze in the right eye. MRI of the orbit showed no evidence of compression of the optic nerve on the right side. Visual-evoked potential showed prolonged P100 in the right eye. Fundus examination revealed swollen optic disc and para papillary nerve fibre layer splinter haemorrhages with corresponding altitudinal field defect on perimetry suggestive of anterior ischaemic optic neuropathy.
Assuntos
Potenciais Evocados Visuais , Doença de Graves/diagnóstico , Neuropatia Óptica Isquêmica/diagnóstico , Adulto , Fundo de Olho , Doença de Graves/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuropatia Óptica Isquêmica/etiologia , Papiledema/etiologiaRESUMO
Among the various forms of migraine headaches, ophthalmoplegic migraine is an uncommon and rare form, the incidence of which is approximately 0.7 per million. It presents predominantly with headache and ophthalmoplegia. One of more cranial nerves can be affected, however the third cranial nerve is most often affected. As a result, symptoms wise, mydriasis and ptosis are commonly seen. Patients generally recover completely within a few days or weeks, however residual deficits are known to occur in a minority of patients. One of the common generalised epilepsy syndromes is the juvenile myoclonic epilepsy (JME), its prevalence being roughly up to 10% of all patients with epilepsy. It usually begins in the second decade of life. Generalised tonic-clonic seizures myoclonic jerks absences constitute the main seizure types in JME. Studies indicate a definite association of epilepsy with migraine headaches and a significant number of migraneurs are found to be epileptic. Conversely, patients with epilepsy are two times more likely to have migraine, as compared to their first degree relatives without migraine. We report a known case of a female patient of JME having a history of classical migraine with aura presenting to us with headache and ophthalmoplegia. She was extensively evaluated to rule out other causes of isolated third cranial nerve palsy, with all the investigations being negative for any obvious cause. She was treated with non-steroidal anti-inflammatory drugs for the acute attack and was subsequently put on antimigraine medication, propranolol during her hospital stay, with which her ptosis recovered completely after 2 weeks. The patient was later started on tablet divalproex sodium, which the patient continues to take on a long-term basis, especially because of its efficacy as an antimigraine prophylaxis agent and a potent drug against JME.
Assuntos
Epilepsia Mioclônica Juvenil/etiologia , Enxaqueca Oftalmoplégica/etiologia , Adulto , Analgésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Feminino , Humanos , Epilepsia Mioclônica Juvenil/tratamento farmacológico , Enxaqueca Oftalmoplégica/tratamento farmacológico , Ácido Valproico/uso terapêuticoRESUMO
Medial medullary syndrome (MMS) is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its branches. In this case report we present a patient who developed MMS secondary to Takayasu arteritis (TA). TA is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of subclavian arteries as well as infarction of the medial medulla bilaterally. To our knowledge this is the first time that MMS has been found to occur secondary to TA.