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Peripheral artery disease exerts a substantial toll on public health in the United States, straining healthcare resources. In challenging cases, the axillofemoral bypass graft had emerged as a cornerstone in managing this condition. Unforeseen events, such as trauma, can lead to a presentation mimicking stroke and thus exacerbating the complexity of the diagnostic process. Herein, we present the case of a 64-year-old male with complex peripheral artery disease who developed a pseudoaneurysm mimicking stroke symptoms following a traumatic incident post axillofemoral bypass graft surgery. This case underscores the critical importance of employing diverse diagnostic modalities to navigate the complex differential diagnosis of stroke-like symptoms in patients post-surgery.
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Eculizumab, a monoclonal antibody against complement C5, is a novel therapy to treat refractory myasthenia gravis (MG). The present review was undertaken to study the role of eculizumab in MG. This includes the drug's mechanism, pharmacokinetics, clinical trial findings, tolerability, side effects, safety, dosage, administration, and cost. An English-language search for relevant items was undertaken using Embase and PubMed from 1946 to present. Clinical trial registries/databases and websites were also searched for relevant data. Keywords were eculizumab and MG. The present review found 103 articles after initial screening. Current data support eculizumab as an effective, safe, and tolerable drug in cases of refractory MG. However, its cost can prevent it from being widely accessible to a majority of the general population.
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Although neuroanatomical and physiological understanding of the cerebellum has evolved over recent decades and continues to develop, there is much that remains to be expounded upon, especially with regard to nonmotor roles. Neurocognitive and language processing is one area where involvement of the cerebellum is no longer in question, but the extent and mechanism of this relationship have yet to be defined. For example, which of the cerebellar hemispheres is involved continues to be debated. We present a case wherein a thrombus in the basilar artery led to bihemispheric cerebellar strokes with profound mixed effects on the patient's language and cognition. To the authors' knowledge, this is the first reported case of bilateral cerebellar strokes resulting in a mixed aphasia reported in scientific literature. This demonstrates the importance of continued research into a model for cerebellar function and the clinical impact of lesions to various cerebellar regions.
Assuntos
Afasia , Isquemia Encefálica , Doenças Cerebelares , Humanos , Afasia/etiologia , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Idioma , Cerebelo/fisiologia , InfartoAssuntos
COVID-19 , SARS-CoV-2 , Humanos , SARS-CoV-2/genética , COVID-19/prevenção & controle , Doença Crônica , Recidiva , VacinaçãoRESUMO
Neurocysticercosis is the most common disease of the nervous system caused by a parasite. Ophthalmological manifestations of cysticercosis typically are due to direct intraorbital or intraocular involvement, parenchymal brainstem involvement, or secondary to hydrocephalus or increased intracranial pressure. We describe a patient with a unilateral fourth nerve palsy, a rare presentation of neurocyticercosis.
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Encéfalo/diagnóstico por imagem , Neurocisticercose/complicações , Doenças do Nervo Troclear/etiologia , Adulto , Biópsia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Neurocisticercose/diagnóstico , Doenças do Nervo Troclear/diagnósticoRESUMO
A 29-year-old male with a history of pilocytic astrocytoma status post-multiple ventriculoperitoneal shunt (VPS) revisions presented with vision loss, ocular motor deficits, and headaches. His shunt was revised but he experienced persistent vision loss despite resolution of his headaches and diplopia. Magnetic resonance imaging (MRI) of the head revealed hydrocephalus and T2 hyperintensity consistent with transependymal oedema surrounding the midbrain, pons, and optic apparatus. His shunt was again revised, but was complicated by an infection that required removal. He underwent an endoscopic third ventriculostomy and an external ventricular device was temporarily placed. Repeat MRI revealed marked improvement of the transependymal oedema and hydrocephalus. His vision returned to baseline and remained stable at 6-months follow-up.
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OBJECTIVES: The aim of this study is to report a case series of atypical presentations of intracranial dysgerminoma in which the diagnosis was delayed due to clinical and radiographic findings initially suggestive of CNS inflammatory or demyelinating diseases, such as MS. METHODS: This study is a case series detailing the history, clinical presentations, radiographic and laboratory results, and management of three patients with biopsy-proven intracranial dysgerminoma. RESULTS: All three patients demonstrated hyperintense lesions on MRI that were more suggestive of demyelinating or inflammatory diseases, including lesions involving the midbrain and corpus callosum. All three patients were serum positive for oligoclonal bands and negative for both AFP and beta-hCG (these two markers are commonly seen in dysgerminoma cases). One case involved a steroid-responsive tumor whereas the other two cases either did not respond to steroids or steroids were withheld due to uncertainty of etiology. Following biopsy, all three results were consistent with dysgerminoma. CONCLUSION: Clinicians should be aware that dysgerminoma may mimic the clinical and radiographic presentations of demyelinating diseases such as MS. These lesions can cause acute visual loss or diplopia, have MRI and CSF findings that might mimic MS, and have been shown to respond to steroids. Atypical clinical (e.g., headache, dorsal midbrain syndrome, bilateral optic neuropathy) or atypical radiographic features (e.g., mass effect, hydrocephalus) should prompt consideration for repeat imaging and possible biopsy even if serum or CSF tumor markers (beta-hCG and AFP) are negative for dysgerminoma.
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Neoplasias Encefálicas/diagnóstico por imagem , Doenças Desmielinizantes/diagnóstico por imagem , Disgerminoma/diagnóstico por imagem , Meningoencefalite/diagnóstico por imagem , Biomarcadores Tumorais/metabolismo , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Doenças Desmielinizantes/metabolismo , Doenças Desmielinizantes/patologia , Diagnóstico Diferencial , Disgerminoma/metabolismo , Disgerminoma/patologia , Feminino , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Meningoencefalite/metabolismo , Meningoencefalite/patologia , Pessoa de Meia-Idade , Proteínas de Neoplasias/metabolismo , Estudos Retrospectivos , Testes de Campo Visual , Campos Visuais/fisiologia , Adulto JovemAssuntos
Arterite de Células Gigantes/diagnóstico , Órbita/diagnóstico por imagem , Pseudotumor Orbitário/etiologia , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Arterite de Células Gigantes/complicações , Humanos , Imageamento por Ressonância Magnética , Pseudotumor Orbitário/diagnóstico , RecidivaRESUMO
BACKGROUND: Horner syndrome arises from a disruption along the oculosympathetic efferent chain and can be caused by a variety of pathological and iatrogenic etiologies. We present 3 cases of postoperative Horner syndrome after bilateral lung transplantation. METHODS: The electronic health records of 3 patients with iatrogenic Horner syndrome after lung transplantation were examined, including notes from each patient's medical history, operative and postoperative records, and ophthalmology consultation results. A literature review was performed. RESULTS: All 3 of our patients displayed anisocoria and ptosis, symptoms consistent with Horner syndrome, and the patients from Cases 1 and 2 showed reversal of anisocoria after an application of topical apraclonidine. CONCLUSIONS: Ophthalmologists should be aware of the risk of Horner syndrome after lung transplantation.
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Síndrome de Horner/etiologia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Acuidade Visual , Feminino , Síndrome de Horner/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This case report highlights utilization of image-guided, percutaneous transorbital direct cavernous sinus puncture to embolize an anteriorly draining carotid cavernous fistula (CCF) when conventional transarterial and transvenous approaches were not feasible. An 86-year-old man with a known posterior draining CCF developed acute unilateral proptosis, pain, and vision loss ("red-eyed shunt"). Cerebral angiogram revealed the dural CCF to be draining anteriorly into partially thrombosed ophthalmic veins. After failed transarterial and transvenous attempts, a percutaneous transorbital approach was used to successfully embolize the fistula using the Onyx Liquid Embolic System according to the visual needle path generated by the Seimens Syngo iGuide. To our knowledge, this is the first reported case of percutaneous transorbital direct embolization of a CCF utilizing the Seimens Syngo iGuide.
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Predisposição Genética para Doença , Judeus , Lipoproteína(a)/sangue , Acidente Vascular Cerebral/sangue , Adulto , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Testes Genéticos , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologiaAssuntos
Arterite de Células Gigantes/diagnóstico , Leucemia Mielomonocítica Crônica/complicações , Vasculite Retiniana/etiologia , Vasos Retinianos/patologia , Artérias Temporais/patologia , Acuidade Visual , Idoso , Biópsia , Diagnóstico Diferencial , Humanos , Leucemia Mielomonocítica Crônica/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Vasculite Retiniana/diagnóstico , Tomografia de Coerência Óptica/métodosAssuntos
Arterite de Células Gigantes/complicações , Perda Auditiva Bilateral/etiologia , Perda Auditiva Neurossensorial/etiologia , Idoso , Biópsia , Progressão da Doença , Arterite de Células Gigantes/diagnóstico , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Artérias Temporais/patologiaRESUMO
An 84-year-old woman reported onset of headaches, diplopia, and blurred vision. On examination, she was found to have a left sixth nerve palsy and an incongruous right homonymous hemianopia. Brain MRI demonstrated a left petroclival meningioma, causing this unusual combination of clinical findings. The patient was treated with radiation therapy and has remained stable over 4 years of follow-up.
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Doenças do Nervo Abducente/etiologia , Encéfalo/diagnóstico por imagem , Hemianopsia/etiologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Neoplasias da Base do Crânio/complicações , Doenças do Nervo Abducente/diagnóstico por imagem , Idoso de 80 Anos ou mais , Feminino , Hemianopsia/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagemRESUMO
Background: In the absence of confirmatory biopsy, the criteria for diagnosis of neuro-ophthalmic sarcoidosis are not well established. Diagnostic criteria for both intraocular sarcoidosis and neurosarcoidosis have been proposed, but the diagnosis of neuro-ophthalmic sarcoidosis remains challenging. It is our intention to augment what is currently known about the diagnosis of neuro-ophthalmic sarcoidosis by providing a series of biopsy-proven cases that contribute to the continued development of diagnostic criteria for this enigmatic condition. Methods: Case series of four Caucasian women with biopsy-proven neuro-ophthalmic sarcoidosis. Results: The first patient was initially diagnosed with traumatic optic neuropathy following a fall. Years later, the presence of pathologic submandibular lymphadenopathy was identified and biopsied, revealing non-caseating granulomas. The second and third cases involved sarcoidosis of the extraocular muscles without clear or common systemic features of sarcoidosis. In the fourth and final case, the patient presented with a Horner syndrome attributed to sarcoid infiltration of the ipsilateral sympathetic chain. Bronchoscopy with biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions: We describe four cases of neuro-ophthalmic sarcoidosis and propose possible neuro-orbital and neuro-ophthalmic criteria both with and without diagnostic biopsy.
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We present a case of endometrial carcinoma (EC) presenting with a third cranial nerve palsy due to metastasis to the cavernous sinus. Although the tumour was only stage 1B, histopathologic features including higher grade and lymphovascular space invasion (LVSI) increase the risk of recurrent and metastatic disease. To our knowledge, this is the first case of EC presenting as a third cranial nerve palsy in the English-language ophthalmic literature. Clinicians should be aware that the risk of metastatic EC including neuro-ophthalmic presentations depends upon not only stage and grade but also the presence of unique histopathological findings such as LVSI.