RESUMO
INTRODUCTION: Sudden bilateral deafness and facial weakness are unusual presentations of brain stem stroke. OBSERVATION: We report the case of a patient who presented successively sudden bilateral deafness and facial diplegia in correlation with a brain stem stroke but without any ischemic pontine lesion. DISCUSSION: Unlike our case, all of the earlier publications, have reported the presence of ischemic pontine lesions in patients with bilateral deafness and facial diplegia. Selective vulnerability of inner ear to ischemia has been hypothesized but cannot explain the facial diplegia. CONCLUSION: Our case would suggest extra-neuraxis failure by ischemia of the acoustico-facial nerve.
Assuntos
Surdez/etiologia , Paralisia Facial/etiologia , Insuficiência Vertebrobasilar/complicações , Doença Aguda , Infartos do Tronco Encefálico/complicações , Infartos do Tronco Encefálico/diagnóstico , Cerebelo/irrigação sanguínea , Cerebelo/patologia , Angiografia Cerebral , Diagnóstico Diferencial , Dominância Cerebral/fisiologia , Paralisia Facial/diagnóstico , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte/irrigação sanguínea , Ponte/patologia , Fluxo Sanguíneo Regional/fisiologia , Insuficiência Vertebrobasilar/diagnósticoRESUMO
In Churg and Strauss syndrome (CSS), three patterns of neurological involvement can be found, including mono or polyneuropathy, encephalopathy and stroke. We report two cases of stroke associated with major hypereosinophilia and cardiac involvement, leading to a diagnosis of CSS. Neurological and general outcome were good under treatment with steroids in combination with cyclophosphamide in one case. Churg and Strauss syndrome must be considered when a stroke is associated with a cardiac involvement and hypereosinophilia.
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Isquemia Encefálica/etiologia , Síndrome de Churg-Strauss/fisiopatologia , Cardiopatias/etiologia , Corticosteroides/uso terapêutico , Adulto , Encéfalo/patologia , Isquemia Encefálica/patologia , Síndrome de Churg-Strauss/patologia , Feminino , Humanos , Síndrome Hipereosinofílica/etiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: Hypoplasia of the internal carotid artery (ICA) is a rare developmental anomaly sometime revealed by transient ischaemic attaks (TIA). Association with a Horner's syndrome is very rare. CASE REPORT: We report the case of a 42-year-old woman who presented with a TIA and a cervical murmur. Horner's syndrome with iris hypopigmentation was present shortly after birth. Magnetic resonance imaging showed no dissection but hypoplasia of the ICA. Blood flow in the ICA was antegrade through several branches constituting a rete mirabile across the carotid canal, and via collateral arteries from ipsilateral external carotid artery. CONCLUSION: Horner's syndrome in the setting of TIA evokes a carotid dissection. A skull base CT scan demonstrating carotid canal hypoplasia can rule out an ICA dissection and allows diagnosis of a congenital arterial anomaly.
Assuntos
Artéria Carótida Interna/anormalidades , Síndrome de Horner/complicações , Ataque Isquêmico Transitório/etiologia , Adulto , Feminino , HumanosRESUMO
BACKGROUND: A substantial proportion of ischemic strokes have an embolic mechanism, but the source of embolism is not detected. Coexistence of subdiaphragmatic visceral infarction (SDVI; e.g., renal, splenic, hepatic, bowel infarction) may be a suggestion of a common source of embolism. One large autopsy study found SDVI in 21.5% of patients with fatal stroke. METHOD: We performed diffusion-weighted magnetic resonance abdominal imaging and subsequently performed it in consecutive patients with stroke or TIA and a history of nonvalvular atrial fibrillation. RESULTS: Among 27 patients, 6 had SDVI (3 recent renal, 1 recent splenic, and 3 old splenic infarction). The median time between onset of ischemic stroke and abdominal MRI was 8 days (interquartile range 3-15 days). No predictive factor of SDVI was found in this study population with respect to demographic or ultrasound characteristics. CONCLUSIONS: One in 5 patients with nonfatal cardioembolic stroke or TIA may be associated with subdiaphragmatic visceral infarction (SDVI). Further study should evaluate the frequency of SDVI in patients with stroke of unknown cause.