RESUMEN
BACKGROUND: Paroxysmal hemicrania has not been associated with ipsilateral weakness, loss of sensation and Horner's syndrome. This report is the first of its kind documented in literature. CASE PRESENTATION: This was an elderly, sixty-five-year-old Chinese male who presented with a headache fulfilling criteria of paroxysmal hemicrania and was found to have signs of ipsilateral conjunctival injection, Horner's syndrome, weakness and loss of sensation; with resolution of the patient's physical signs after relief of the headache. Brain magnetic resonance imaging did not show any strokes or other headache mimics. The patient had a marked response to indomethacin and a decrease of headache intensity and frequency with indomethacin prophylaxis. CONCLUSIONS: Paroxysmal hemicrania has joined the list of stroke chameleons and that it would be one of the differentials in a patient with hemiplegia, hemisensory loss, autonomic signs and severe headache. It suggests that paroxysmal hemicrania in the elderly present atypically.
Asunto(s)
Cefalea/etiología , Hemicránea Paroxística/diagnóstico , Actividades Cotidianas , Anciano , Encéfalo/fisiopatología , Humanos , Indometacina/uso terapéutico , Masculino , Hemicránea Paroxística/tratamiento farmacológico , Accidente Cerebrovascular/diagnóstico , Resultado del TratamientoRESUMEN
BACKGROUND: Dementia with Lewy bodies (DLB) is still underdiagnosed or mistaken for other types of neurodegenerative diseases. Biomarkers such as 18-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) can be helpful. CASE PRESENTATION: A 72-year-old gentleman presented with postural hypotension, hallucination, Parkinsonism and recurrent falls. He also had rapidly progressing cognitive impairment. CT and MRI brain showed atrophy of the frontal lobes with preservation of the hippocampi. FDG-PET was suggestive of DLB. He was subsequently treated with Rivastigmine, with significant improvement of his symptoms. CONCLUSION: This case highlights the challenges in diagnosis of an elderly patient with DLB, the use of neuro-imaging as a diagnostic biomarker, the avoidance of the use of antipsychotic and the response to pharmacological treatment with Rivastigmine after a probable diagnosis of DLB.