RESUMEN
Strokes involving posterior inferior cerebellar arteries (PICA) are rare and usually unilateral. They can involve either the lateral division or the medial division of PICA. Sudden simultaneous cerebellar infarctions in the medial PICA territories are extremely rare. We report one such patient who presented with acute bilateral cerebellar infarctions in the medial PICA territories. She was a diabetic and had features of diffuse atherosclerotic vertebrobasilar disease. We discuss the anatomical peculiarities of PICA and its blood supply along with the clinical features differentiating the medial and lateral PICA infarctions. We also list out the possible mechanisms of bilateral medial PICA territory infarction. Though bilateral they generally have a good prognosis considering the very small area of blood supply.
Asunto(s)
Cerebelo/irrigación sanguínea , Arterias Cerebrales , Infarto Cerebral , Infarto Cerebral/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Parry-Romberg syndrome is a rare clinical entity characterised by progressive hemifacial atrophy with appearance of 'saber'. Various neurological and otorhinolaryngological disorders are associated with this syndrome. The association of Parry -Romberg syndrome with Spasmodic dysphonia has rarely been reported. A 37 year old female presented with progressive atrophy of tissues of left side of face for 10 years and change in voice for 1 year. On examination, wasting and atrophy of tissues including tongue was noted on left side of the face. ENT examination revealed adductor spasmodic dysphonia. We report the rare association of Parry -Romberg syndrome with spasmodic dysphonia.
Asunto(s)
Disfonía/etiología , Hemiatrofia Facial/complicaciones , Hemiatrofia Facial/diagnóstico , Adulto , Disfonía/diagnóstico , Femenino , HumanosRESUMEN
Objectives: Demyelinating diseases of central nervous system (CNS) are a broad spectrum of conditions with autoimmune process against myelin. In a resource limited country like India, it is imperative to perform proper clinical evaluation, neuroimaging to differentiate among various categories of CNS demyelinating diseases to decide regarding further workup and treatment. The objective of our study was to determine clinical presentation, imaging findings, serology results, diagnosis, and treatment outcome of primary demyelinating disorders of CNS. Materials and Methods: In this prospective study, a total of 44 patients were enrolled over a period of 1 year. After proper evaluation, patients were categorized into different groups applying newer diagnostic criteria. Patients were treated with steroids, appropriate immunomodulatory therapy, and outcomes were analyzed. Results: The majority of cases were of neuromyelitis optica spectrum disorder (NMOSD) (45.5%) with an overall female-to-male ratio of 3.4:1 and mean age of presentation was 30.5 ± 11.15. Myelitis (52.3%) followed by optic neuritis (45.5%) was the most common initial presentation. The most common site of involvement on magnetic resonance imaging was the spinal cord (particularly the cervicodorsal cord). The majority showed good response to therapy (77.27%) and two patients did not survive. Conclusion: Higher disability observed among seropositive NMOSD patients warrants aggressive treatment during the first attack itself. It is important to suspect myelin oligodendrocyte glycoprotein antibody disease in patients with preceding viral infection. A good outcome in the majority is likely due to the availability of serological assays and aggressive immunomodulatory therapy.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/etiología , Trombosis del Seno Lateral/complicaciones , Trombosis del Seno Lateral/diagnóstico por imagen , Angiografía de Substracción Digital , Resultado Fatal , Humanos , Angiografía por Resonancia Magnética , Persona de Mediana EdadAsunto(s)
Anestesia General/efectos adversos , Ceguera/etiología , Síndromes Compartimentales/etiología , Descompresión Quirúrgica/efectos adversos , Imagen por Resonancia Magnética , Músculos Oculomotores/diagnóstico por imagen , Enfermedades Orbitales/etiología , Adulto , Ceguera/diagnóstico , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/tratamiento farmacológico , Humanos , Vértebras Lumbares/cirugía , Masculino , Metilprednisolona/uso terapéutico , Oftalmoplejía/diagnóstico , Oftalmoplejía/tratamiento farmacológico , Oftalmoplejía/etiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Complicaciones Posoperatorias/diagnóstico , Posición Prona , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/tratamiento farmacológico , Trastornos de la Visión/etiologíaRESUMEN
The familial episodic ataxia type II is a rare, dominantly inherited disease characterized by episodes of ataxia of early onset, often with completely normal cerebellar function between attacks. We report a family with affected members who had features of episodic ataxia type II and cerebellar atrophy on MRI imaging. All the affected members were successfully treated with acetazolamide, a carbonic anhydrase inhibitor. They are asymptomatic at 2 year follow-up.
Asunto(s)
Acetazolamida/uso terapéutico , Ataxia/tratamiento farmacológico , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Nistagmo Patológico/tratamiento farmacológico , Adolescente , Adulto , Anciano , Ataxia/diagnóstico , Ataxia/genética , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/genética , Linaje , Adulto JovenAsunto(s)
Acidosis Tubular Renal/etiología , Hipopotasemia/etiología , Parálisis/etiología , Síndrome de Sjögren/complicaciones , Acetazolamida/uso terapéutico , Acidosis Tubular Renal/diagnóstico , Acidosis Tubular Renal/terapia , Adulto , Femenino , Humanos , Hipopotasemia/diagnóstico , Hipopotasemia/terapia , Inmunosupresores/uso terapéutico , Potasio/uso terapéutico , Prednisolona/uso terapéutico , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/etiología , Síndrome de Sjögren/terapia , Resultado del TratamientoRESUMEN
We report about two young males who developed significant proximal weakness of all four limbs secondary to intracranial hypertension due to intracranial venous sinus thrombosis. Intracranial venous sinus thrombosis can manifest in a variety of ways which includes isolated intracranial hypertension, focal neurological symptoms or signs and acute or subacute encephalopathy. Various false localising signs have been reported to occur in patients with raised intracranial pressure including cranial nerve palsies and extensive radiculopathy. In a patient presenting with flaccid areflexic quadriparesis and papilledema, the possibility of a potentially reversible dysfunction of the cranial nerves and spinal nerve roots due to a marked rise in intracranial and intraspinal pressure must be recognised. Lumboperitoneal shunt to reduce the intraspinal pressure on the spinal nerve roots has been advocated to reverse the symptoms of extensive radiculopathy in such patients. Both of our patients showed remarkable improvement in symptoms and signs with medical treatment of CVT.
Asunto(s)
Hipertensión Intracraneal , Papiledema , Polirradiculopatía , Trombosis de los Senos Intracraneales , Senos Craneales , Humanos , Masculino , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico por imagenAsunto(s)
Encéfalo/patología , Hemorragia Cerebral/diagnóstico , Eclampsia/diagnóstico , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Hemorragia Cerebral/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Síndrome de Leucoencefalopatía Posterior/etiología , Embarazo , Adulto JovenRESUMEN
Focal neurological symptoms may provide the first clue to the presence of nonketotic hyperglycemia (NKH). We report a patient with hemichorea-hemiballism (HC-HB) as the first manifestation of NKH. CT Brain revealed hyperdensity in bilateral globus pallidus (GP) and putamen predominantly on right side. Blood sugar was 580 mg/dl and s. osmolality was 316 mosm/l. This condition resolved after correction of hyperglycemia. The possible mechanism by which NKH causes this condition is discussed.
Asunto(s)
Discinesias/etiología , Globo Pálido/diagnóstico por imagen , Hiperglucemia/diagnóstico , Putamen/diagnóstico por imagen , Anciano , Complicaciones de la Diabetes , Diagnóstico Diferencial , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Cetosis/complicaciones , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Neurological deficits can occur following snake bite. It is usually due to intracerebral haemorrhage or subarachnoid bleed as a result of depletion of clotting factors. A healthy 14-years-old male developed bilateral ptosis and altered sensorium within 3 hours of snake bite. CT Brain revealed bilateral cerebellar and right occipital infarction with mass effect. Clotting time and bleeding time were normal. The possible mechanism for infarction in this patient is discussed.